Provider Demographics
NPI:1306012489
Name:BELLMORE-WANTAGH ADULT MEDICINE, PLLC
Entity Type:Organization
Organization Name:BELLMORE-WANTAGH ADULT MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-785-2783
Mailing Address - Street 1:2857 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2018
Mailing Address - Country:US
Mailing Address - Phone:516-785-2783
Mailing Address - Fax:516-785-2584
Practice Address - Street 1:2857 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2018
Practice Address - Country:US
Practice Address - Phone:516-785-2783
Practice Address - Fax:516-785-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty