Provider Demographics
NPI:1497086235
Name:ISLAND NEPHROLOGY PC
Entity Type:Organization
Organization Name:ISLAND NEPHROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHFAQ
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-456-4447
Mailing Address - Street 1:18 FIELDHOUSE AVE
Mailing Address - Street 2:EAST SETAUKET
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1038
Mailing Address - Country:US
Mailing Address - Phone:631-456-4447
Mailing Address - Fax:561-282-3238
Practice Address - Street 1:4 TECHNOLOGY DRIVE
Practice Address - Street 2:SUITE-130
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-479-3743
Practice Address - Fax:561-282-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197431207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7X4431OtherBCBS
NY03250268Medicaid
NYA100030775Medicare PIN