Pottanat, Marie T

Pottanat, Marie T is an individual health care provider with primary practice located at 640 Hawkins Ave , Lake Ronkonkoma NY 11779-2324. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Pottanat, Marie T can be contacted via phone (631) 737-0100.

Contact Information

Primary practice address
640 Hawkins Ave Lake Ronkonkoma NY 11779-2324
Phone: (631) 737-0100
Fax: (631) 417-1117
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 143538 New York

Profile Details

NPI number 1114966306
LBN Legal business name Pottanat, Marie T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 5th, 2006
Last updated Oct 8th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114966306 NPPES
New York MEDICAID 01723537

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