Provider Demographics
NPI:1629387725
Name:JOHN LABIAK MD PC
Entity Type:Organization
Organization Name:JOHN LABIAK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LABIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-265-1855
Mailing Address - Street 1:290 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2916
Mailing Address - Country:US
Mailing Address - Phone:631-265-1855
Mailing Address - Fax:631-724-2579
Practice Address - Street 1:290 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2916
Practice Address - Country:US
Practice Address - Phone:631-265-1855
Practice Address - Fax:631-724-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173947174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1396747267Medicaid
NY1396747267Medicaid