| NPI | 1912460791 |
|---|---|
| Doing Business As | PORT MD MEDICAL WELLNESS |
| Entity Type | Organization |
| Authorized Contact | MARKELLA CHRISTAKIS Billing 631-403-4310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2019-10-01 |