Provider Demographics
NPI:1417187485
Name:LONG ISLAND MEDICAL OFFICE BASED SURGERY PLLC
Entity Type:Organization
Organization Name:LONG ISLAND MEDICAL OFFICE BASED SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KREINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-939-6695
Mailing Address - Street 1:1074 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4918
Mailing Address - Country:US
Mailing Address - Phone:516-939-6695
Mailing Address - Fax:516-939-2392
Practice Address - Street 1:1074 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4918
Practice Address - Country:US
Practice Address - Phone:516-939-6695
Practice Address - Fax:516-939-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1517981261QA0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility