NPI 1104960962

Professional Evaluation Medical Group

Organisation Exclusive Provider Organization Hicksville, NY

Practice location

Address: 380 S Broadway, Hicksville, NY 11801-5033
Phone: (516) 935-4378
Fax: (516) 931-3117

Authorised official

Name: James Michael Sheehy
Title: Executive Director
Phone: (516) 935-4378

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 147150 (NY)

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Registry record

NPI: 1104960962
Entity type: Organization
NPI issued: 16 Feb 2007
Record last updated: 10 Nov 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.