Provider Demographics
NPI:1710281043
Name:CENTRAL ISLAND INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:CENTRAL ISLAND INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAQUINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-850-8451
Mailing Address - Street 1:202 FALLWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4929
Mailing Address - Country:US
Mailing Address - Phone:516-249-1999
Mailing Address - Fax:516-249-1919
Practice Address - Street 1:202 FALLWOOD PKWY
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4929
Practice Address - Country:US
Practice Address - Phone:516-249-1999
Practice Address - Fax:516-249-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY198062OtherNYS LICENSE
NY198062OtherNYS LICENSE