Provider Demographics
NPI:1487731279
Name:LONG ISLAND HEALTH & WELLNESS FAMILY MEDICINE, P.C.
Entity type:Organization
Organization Name:LONG ISLAND HEALTH & WELLNESS FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONATO
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BALSAMO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-691-1500
Mailing Address - Street 1:282A HIGBIE LANE
Mailing Address - Street 2:#279
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-691-1500
Mailing Address - Fax:631-691-1503
Practice Address - Street 1:197 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701
Practice Address - Country:US
Practice Address - Phone:631-691-1500
Practice Address - Fax:631-691-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty