Provider Demographics
NPI:1659500106
Name:LONG ISLAND MEDICAL P.C.
Entity Type:Organization
Organization Name:LONG ISLAND MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYDEEP
Authorized Official - Middle Name:SHIVAJI
Authorized Official - Last Name:KADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-584-6400
Mailing Address - Street 1:237 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4513
Mailing Address - Country:US
Mailing Address - Phone:516-584-6400
Mailing Address - Fax:516-584-6401
Practice Address - Street 1:237 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4513
Practice Address - Country:US
Practice Address - Phone:516-584-6400
Practice Address - Fax:516-584-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238095207RG0100X
NY220299207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty