| Haven Medical Services, Plc | |
|
1350 Route 112 Port Jefferson Station NY 11776-3078 | |
| (631) 473-3304 | |
| (631) 474-1692 |
| Full Name | Haven Medical Services, Plc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1350 Route 112, Port Jefferson Station, New York |
| Authorized Official Name and Position | Corazon M Go (OWNER) |
| Authorized Official Contact | 6314733304 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Haven Medical Services, Plc 1350 Route 112 Port Jefferson Station NY 11776-3078 Ph: (631) 473-3304 | Haven Medical Services, Plc 1350 Route 112 Port Jefferson Station NY 11776-3078 Ph: (631) 473-3304 |
| NPI Number | 1235301185 |
|---|---|
| Provider Enumeration Date | 04/01/2008 |
| Last Update Date | 04/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235301185 | NPI | - | NPPES |
| 00211463 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 115112 (New York) | Primary |
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