Provider Demographics
NPI:1699392357
Name:LONG ISLAND PEDIATRICS OF PATCHOGUE PC
Entity Type:Organization
Organization Name:LONG ISLAND PEDIATRICS OF PATCHOGUE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:E
Authorized Official - Last Name:FERRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-333-9800
Mailing Address - Street 1:475 E MAIN ST STE 109
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3121
Mailing Address - Country:US
Mailing Address - Phone:631-333-9800
Mailing Address - Fax:
Practice Address - Street 1:475 E MAIN ST STE 109
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-333-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty