Provider Demographics
NPI:1467780072
Name:LONG ISLAND FERTILITY & ENDOCRINOLOGY ASSOC., PC
Entity Type:Organization
Organization Name:LONG ISLAND FERTILITY & ENDOCRINOLOGY ASSOC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-881-5294
Mailing Address - Street 1:8 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3193
Mailing Address - Country:US
Mailing Address - Phone:631-752-0606
Mailing Address - Fax:
Practice Address - Street 1:8 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3193
Practice Address - Country:US
Practice Address - Phone:631-752-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360219-1261QA0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility