| Organization Name: | MEDICAL HOUSE CALLS OF THE NORTH FORK, PLLC |
| NPI Number: | 1083009476 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NATHANAEL DESIRE (OWNER) |
| Mailing Address: | 53 Osprey Nest Rd Greenport |
| State: | NY US |
| Postal Code: | 119442521 |
| Phone Number: | 6318067341 |
| Fax Number: | 6314776219 |
| NPI Enumeration Date: | 04/02/2015 |
| NPI Last Update Date: | 11/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 216602 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |