Provider Demographics
NPI:1588004154
Name:WALT WHITMAN AA, LLC
Entity Type:Organization
Organization Name:WALT WHITMAN AA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOUNGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-293-9700
Mailing Address - Street 1:718 WALT WHITMAN RD
Mailing Address - Street 2:PO BOX 1109
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-6600
Mailing Address - Country:US
Mailing Address - Phone:631-293-9700
Mailing Address - Fax:631-293-2021
Practice Address - Street 1:1895 WALT WHITMAN RD
Practice Address - Street 2:STE 10
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3031
Practice Address - Country:US
Practice Address - Phone:631-293-9700
Practice Address - Fax:631-293-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty