Provider Demographics
NPI:1366004814
Name:ORTHOPEDIC ASSOC OF LONG ISLAND PHYSICIANS & MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOC OF LONG ISLAND PHYSICIANS & MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUOPOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-689-6698
Mailing Address - Street 1:PO BOX 45776
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-5776
Mailing Address - Country:US
Mailing Address - Phone:631-689-6698
Mailing Address - Fax:
Practice Address - Street 1:500 COMMACK RD UNIT 150
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5009
Practice Address - Country:US
Practice Address - Phone:631-689-6698
Practice Address - Fax:631-751-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies