Provider Demographics
NPI:1053508994
Name:ALL ISLAND MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:ALL ISLAND MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PINNAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-589-7787
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-0447
Mailing Address - Country:US
Mailing Address - Phone:631-589-7787
Mailing Address - Fax:631-589-3908
Practice Address - Street 1:1099 SMITHTOWN AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2127
Practice Address - Country:US
Practice Address - Phone:631-589-7787
Practice Address - Fax:631-589-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194215-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEE721Medicare PIN