OrganizationActive
300 Old Country Road Medical PLLC
NPI 1164935276 · Obstetrics & Gynecology Physician · Mineola, NY
Provider details
- NPI number
- 1164935276
- Entity type
- Organization
- Primary specialty
- Obstetrics & Gynecology PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Lawrence Tydings, Medical Director
Practice location
300 Old Country Rd Ste 201
Mineola, NY 11501-4199
Phone: (516) 702-4924
Mailing address
1231 Moores Hill Rd
Syosset, NY 11791-9631
Registry dates
- Enumerated
- 2017-11-10
- Last updated
- 2017-11-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.