Provider Demographics
NPI:1073682639
Name:HEART ASSOCIATES OF LONG ISLAND PLLC
Entity Type:Organization
Organization Name:HEART ASSOCIATES OF LONG ISLAND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REITANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-941-2273
Mailing Address - Street 1:220 N BELLE MEAD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3458
Mailing Address - Country:US
Mailing Address - Phone:631-941-2273
Mailing Address - Fax:631-941-3090
Practice Address - Street 1:220 N BELLE MEAD RD
Practice Address - Street 2:SUITE A
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3458
Practice Address - Country:US
Practice Address - Phone:631-941-2273
Practice Address - Fax:631-941-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWMW061Medicare PIN