Provider Demographics
NPI:1306196936
Name:PRIMARY MEDICAL ASSOCIATES OF LONG ISLAND PLLC
Entity Type:Organization
Organization Name:PRIMARY MEDICAL ASSOCIATES OF LONG ISLAND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-506-7776
Mailing Address - Street 1:54 SUNNYSIDE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1517
Mailing Address - Country:US
Mailing Address - Phone:516-506-7776
Mailing Address - Fax:516-719-0708
Practice Address - Street 1:54 SUNNYSIDE BLVD STE E
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1517
Practice Address - Country:US
Practice Address - Phone:516-506-7776
Practice Address - Fax:516-719-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33D2057234OtherCLIA
NY33D2057234OtherCLIA