Provider Demographics
NPI:1568630119
Name:LONG ISLAND FERTILITY & ENDOCRINOLOGY IVF ASSOCIATES, PC
Entity Type:Organization
Organization Name:LONG ISLAND FERTILITY & ENDOCRINOLOGY IVF ASSOCIATES, PC
Other - Org Name:LABORATORY AT LONG ISLAND IVF, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, MANAGED CARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-678-3428
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:
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:2008-02-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN