Provider Demographics
NPI:1669497863
Name:LONG ISLAND ARRHYTHMIA ASSOCIATES LLC
Entity Type:Organization
Organization Name:LONG ISLAND ARRHYTHMIA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENCZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-357-2780
Mailing Address - Street 1:515 ROUTE 111
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4339
Mailing Address - Country:US
Mailing Address - Phone:631-224-1819
Mailing Address - Fax:631-224-1812
Practice Address - Street 1:515 ROUTE 111 FL 2
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4339
Practice Address - Country:US
Practice Address - Phone:631-224-1819
Practice Address - Fax:631-224-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02694879Medicaid
NY02694879Medicaid
NY07123JMedicare ID - Type Unspecified