Provider Demographics
NPI:1114292802
Name:FAMILY MEDICINE OF LI PC
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF LI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONSEF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-320-3200
Mailing Address - Street 1:3650 ROUTE 112
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-4131
Mailing Address - Country:US
Mailing Address - Phone:631-320-3200
Mailing Address - Fax:631-880-7603
Practice Address - Street 1:3650 ROUTE 112
Practice Address - Street 2:SUITE 101
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4131
Practice Address - Country:US
Practice Address - Phone:631-320-3200
Practice Address - Fax:631-880-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty