Provider Demographics
NPI:1023134384
Name:LONG ISLAND MEDICAL AND GASTROENTEROLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:LONG ISLAND MEDICAL AND GASTROENTEROLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FAELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-650-4604
Mailing Address - Street 1:192 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2416
Mailing Address - Country:US
Mailing Address - Phone:516-487-4500
Mailing Address - Fax:516-487-7439
Practice Address - Street 1:192 E SHORE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2416
Practice Address - Country:US
Practice Address - Phone:516-487-4500
Practice Address - Fax:516-487-7439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty