Provider Demographics
NPI:1952713281
Name:EAST END URGENT & PRIMARY CARE MEDICINE PLLC
Entity Type:Organization
Organization Name:EAST END URGENT & PRIMARY CARE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:VELIATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-603-3400
Mailing Address - Street 1:9 KERRY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-5251
Mailing Address - Country:US
Mailing Address - Phone:631-603-3400
Mailing Address - Fax:631-603-3401
Practice Address - Street 1:1228 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2675
Practice Address - Country:US
Practice Address - Phone:631-603-3400
Practice Address - Fax:631-603-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1634232207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty