Provider Demographics
NPI:1215601158
Name:LONG ISLAND MEDICAL INTERVENTIONAL SERVICES PLLC
Entity Type:Organization
Organization Name:LONG ISLAND MEDICAL INTERVENTIONAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRUSHA
Authorized Official - Middle Name:NARENDRA
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-605-0600
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-0676
Mailing Address - Country:US
Mailing Address - Phone:516-605-0600
Mailing Address - Fax:
Practice Address - Street 1:4273 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5710
Practice Address - Country:US
Practice Address - Phone:516-605-0600
Practice Address - Fax:516-321-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty