Provider Demographics
NPI:1477704005
Name:ISLAND MEDICAL HOUSE DOCTOR PC
Entity Type:Organization
Organization Name:ISLAND MEDICAL HOUSE DOCTOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-514-7600
Mailing Address - Street 1:88 ARKAY DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3757
Mailing Address - Country:US
Mailing Address - Phone:631-514-7600
Mailing Address - Fax:631-514-7601
Practice Address - Street 1:88 ARKAY DR
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3757
Practice Address - Country:US
Practice Address - Phone:631-514-7600
Practice Address - Fax:631-514-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY170935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty