Provider Demographics
NPI:1427178847
Name:ISLAND TOTAL MEDICAL CARE
Entity Type:Organization
Organization Name:ISLAND TOTAL MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LIVOTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-226-8600
Mailing Address - Street 1:502 S WELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4911
Mailing Address - Country:US
Mailing Address - Phone:631-226-8600
Mailing Address - Fax:631-957-7858
Practice Address - Street 1:502 S WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4911
Practice Address - Country:US
Practice Address - Phone:631-226-8600
Practice Address - Fax:631-957-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty