Provider Demographics
NPI:1710074935
Name:OTOLARYNGOLOGY ASSOCIATES OF LONG ISLAND
Entity Type:Organization
Organization Name:OTOLARYNGOLOGY ASSOCIATES OF LONG ISLAND
Other - Org Name:LITMAN, SHER, SHANGOLD, M.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:LITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-928-0188
Mailing Address - Street 1:251 E OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2602
Mailing Address - Country:US
Mailing Address - Phone:631-928-0188
Mailing Address - Fax:631-928-0185
Practice Address - Street 1:251 E OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2602
Practice Address - Country:US
Practice Address - Phone:631-928-0188
Practice Address - Fax:631-928-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01793902Medicaid
NYW03541Medicare ID - Type Unspecified