Provider Demographics
NPI:1497946735
Name:LONG ISLAND GERIATRIC MEDICAL ASSOC PC
Entity Type:Organization
Organization Name:LONG ISLAND GERIATRIC MEDICAL ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RABER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-942-7740
Mailing Address - Street 1:108 IVY ST
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-3504
Mailing Address - Country:US
Mailing Address - Phone:516-942-7740
Mailing Address - Fax:516-942-7740
Practice Address - Street 1:108 IVY ST
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-3504
Practice Address - Country:US
Practice Address - Phone:516-942-7740
Practice Address - Fax:516-942-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty