Provider Demographics
NPI:1649409707
Name:ORTHOPEDIC ASSOCIATES OF LONG ISLAND, LLP
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF LONG ISLAND, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-689-4166
Mailing Address - Street 1:6 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4079
Mailing Address - Country:US
Mailing Address - Phone:631-689-6698
Mailing Address - Fax:631-751-5548
Practice Address - Street 1:6144 ROUTE 25A
Practice Address - Street 2:BUILDING C
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2018
Practice Address - Country:US
Practice Address - Phone:631-689-6698
Practice Address - Fax:631-751-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWX0281Medicare UPIN
NY6266750002Medicare NSC