Provider Demographics
NPI:1093930653
Name:LONG ISLAND SPINE & ORTHOPEDICS, PC
Entity Type:Organization
Organization Name:LONG ISLAND SPINE & ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAFIY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-433-1100
Mailing Address - Street 1:87 WEST OLD COUNTRY RD.
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801
Mailing Address - Country:US
Mailing Address - Phone:516-433-1100
Mailing Address - Fax:516-433-1342
Practice Address - Street 1:87 WEST OLD COUNTRY RD.
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801
Practice Address - Country:US
Practice Address - Phone:516-433-1100
Practice Address - Fax:516-433-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1957381207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01494884Medicaid
NYF95655Medicare UPIN