Provider Demographics
NPI:1467589861
Name:LONG ISLAND PEDIATRIC OPHTHALMOLOGY & STRABISMUS, P.C.
Entity Type:Organization
Organization Name:LONG ISLAND PEDIATRIC OPHTHALMOLOGY & STRABISMUS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MARMOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-474-4200
Mailing Address - Street 1:60 N COUNTRY RD
Mailing Address - Street 2:301
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2188
Mailing Address - Country:US
Mailing Address - Phone:631-474-4200
Mailing Address - Fax:631-474-4202
Practice Address - Street 1:60 N COUNTRY RD
Practice Address - Street 2:301
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2188
Practice Address - Country:US
Practice Address - Phone:631-474-4200
Practice Address - Fax:631-474-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty