Provider Demographics
NPI:1134634645
Name:LONG ISLAND PHYSICIAN AFFILIATES, PLLC
Entity Type:Organization
Organization Name:LONG ISLAND PHYSICIAN AFFILIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VON LINTIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-503-1400
Mailing Address - Street 1:333 ROUTE 25A STE 225
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8802
Mailing Address - Country:US
Mailing Address - Phone:631-503-1400
Mailing Address - Fax:
Practice Address - Street 1:635 BELLE TERRE RD STE 209
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1935
Practice Address - Country:US
Practice Address - Phone:631-503-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONG ISLAND PHYSICIAN ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-06
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty