| Omni Medical 360 Pllc | |
|
100 Maple Ave Smithtown NY 11787-3519 | |
| (631) 813-7788 | |
| Not Available |
| Full Name | Omni Medical 360 Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 100 Maple Ave, Smithtown, New York |
| Authorized Official Name and Position | Matthew Lobosco (OWNER) |
| Authorized Official Contact | 6318137788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Omni Medical 360 Pllc 100 Maple Ave Smithtown NY 11787-3519 Ph: (631) 813-7788 | Omni Medical 360 Pllc 100 Maple Ave Smithtown NY 11787-3519 Ph: (631) 813-7788 |
| NPI Number | 1114780525 |
|---|---|
| Provider Enumeration Date | 01/31/2024 |
| Last Update Date | 01/31/2024 |
| Certification Date | 01/31/2024 |
| Medicare PECOS PAC ID | 3476090374 |
|---|---|
| Medicare Enrollment ID | O20240808002259 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114780525 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Matthew Lobosco |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487896148 PECOS PAC ID: 6204121395 Enrollment ID: I20240808002345 |
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