Provider Demographics
NPI:1114165909
Name:COLON AND RECTAL SURGEONS OF LONG ISLAND, P.C.
Entity Type:Organization
Organization Name:COLON AND RECTAL SURGEONS OF LONG ISLAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEIBOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-689-2600
Mailing Address - Street 1:3400 NESCONSET HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3327
Mailing Address - Country:US
Mailing Address - Phone:631-689-2600
Mailing Address - Fax:631-689-2943
Practice Address - Street 1:3400 NESCONSET HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3327
Practice Address - Country:US
Practice Address - Phone:631-689-2600
Practice Address - Fax:631-689-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142014208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27F472Medicare PIN
NYE17722Medicare UPIN