Provider Demographics
NPI:1508924044
Name:LONG ISLAND LUNG CENTER LLP
Entity Type:Organization
Organization Name:LONG ISLAND LUNG CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENGELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-666-5864
Mailing Address - Street 1:370 EAST MAIN STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-666-5864
Mailing Address - Fax:631-666-1187
Practice Address - Street 1:370 EAST MAIN STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-666-5864
Practice Address - Fax:631-666-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W6L611Medicare ID - Type Unspecified