Provider Demographics
NPI:1225255524
Name:INFECTIOUS DISEASE MEDICAL PRACTICE OF NY LLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE MEDICAL PRACTICE OF NY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-864-6111
Mailing Address - Street 1:16 MEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-5228
Mailing Address - Country:US
Mailing Address - Phone:631-864-6111
Mailing Address - Fax:631-486-4498
Practice Address - Street 1:48 ROUTE 25A
Practice Address - Street 2:SUITE 308
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1431
Practice Address - Country:US
Practice Address - Phone:631-864-6111
Practice Address - Fax:631-864-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty