Provider Demographics
NPI:1972042075
Name:CENTER MORICHES MEDICAL HEALTHCARE PC
Entity Type:Organization
Organization Name:CENTER MORICHES MEDICAL HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEITZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-243-8660
Mailing Address - Street 1:131 SUNNYSIDE BLVD
Mailing Address - Street 2:STE100
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1539
Mailing Address - Country:US
Mailing Address - Phone:516-243-8660
Mailing Address - Fax:516-342-6179
Practice Address - Street 1:2 UNION AVE
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3324
Practice Address - Country:US
Practice Address - Phone:516-243-8660
Practice Address - Fax:516-342-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty