Provider Demographics
NPI:1366463234
Name:LONG ISLAND GYNECOLOGIC ONCOLOGISTS, PC
Entity Type:Organization
Organization Name:LONG ISLAND GYNECOLOGIC ONCOLOGISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-864-5440
Mailing Address - Street 1:1077 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3204
Mailing Address - Country:US
Mailing Address - Phone:631-864-5440
Mailing Address - Fax:631-864-5440
Practice Address - Street 1:1077 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3204
Practice Address - Country:US
Practice Address - Phone:631-864-5440
Practice Address - Fax:631-864-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01796625Medicaid
NYW1L752Medicare ID - Type Unspecified