Provider Demographics
NPI:1184151003
Name:LONG ISLAND PODIATRY GROUP, P.C.
Entity type:Organization
Organization Name:LONG ISLAND PODIATRY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPRIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-837-9268
Mailing Address - Street 1:375 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1156
Mailing Address - Country:US
Mailing Address - Phone:516-825-4070
Mailing Address - Fax:516-568-2318
Practice Address - Street 1:1991 MARCUS AVE STE M103
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2040
Practice Address - Country:US
Practice Address - Phone:516-327-0074
Practice Address - Fax:516-327-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02661672Medicaid