Provider Demographics
NPI:1720194780
Name:ORTHOPAEDIC SURGEONS OF LI ASSOC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGEONS OF LI ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAMBROSIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-775-7898
Mailing Address - Street 1:410 LAKEVILLE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1120
Mailing Address - Country:US
Mailing Address - Phone:516-775-7898
Mailing Address - Fax:516-775-4796
Practice Address - Street 1:410 LAKEVILLE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1120
Practice Address - Country:US
Practice Address - Phone:516-775-7898
Practice Address - Fax:516-775-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63531Medicare UPIN
NY4050000001Medicare NSC
NY1194740977Medicare NSC
NY1720194780Medicare NSC
NYE98550Medicare UPIN
NYC08977Medicare UPIN
NY1679598445Medicare NSC
NY1639146913Medicare NSC
NY1316917412Medicare NSC
NYI39874Medicare UPIN