Provider Demographics
NPI:1073669479
Name:ISLAND INTERNIST PC
Entity Type:Organization
Organization Name:ISLAND INTERNIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMINARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-967-1700
Mailing Address - Street 1:420 LYNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6131
Mailing Address - Country:US
Mailing Address - Phone:718-967-1700
Mailing Address - Fax:718-967-7099
Practice Address - Street 1:420 LYNDALE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6131
Practice Address - Country:US
Practice Address - Phone:718-967-5630
Practice Address - Fax:718-967-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179723208D00000X
NY234387208D00000X
NY22415208D00000X
NY171607208D00000X
NY234484208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1124001599OtherNPI #
NY1336194281OtherNPI #
NY1376580662OtherNPI #
NY1861448896OtherNPI#
NY1750476289OtherNPI#
NYE69917Medicare UPIN
NYH80965Medicare UPIN
NY1750476289OtherNPI#
NYI54046Medicare UPIN
NY1124001599OtherNPI #