| Organization Name: | TMH MEDICAL HOME PC |
| NPI Number: | 1063846194 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BELLAMY BROOK (MEDICAL DIRECTOR) |
| Mailing Address: | 1274 E Main St Riverhead |
| State: | NY US |
| Postal Code: | 119012583 |
| Phone Number: | 6312843793 |
| Fax Number: | 6317293111 |
| NPI Enumeration Date: | 08/26/2013 |
| NPI Last Update Date: | 02/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | 215053 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |