Provider Demographics
NPI:1821828047
Name:STATION MEDICAL PC
Entity type:Organization
Organization Name:STATION MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER (NP)
Authorized Official - Prefix:
Authorized Official - First Name:MUBUSHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:631-983-3237
Mailing Address - Street 1:1757 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2407
Mailing Address - Country:US
Mailing Address - Phone:631-983-3237
Mailing Address - Fax:
Practice Address - Street 1:1757 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2407
Practice Address - Country:US
Practice Address - Phone:631-983-3237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty