Provider Demographics
NPI:1720371248
Name:LONG ISLAND HOME MEDICAL CARE, P.C.
Entity Type:Organization
Organization Name:LONG ISLAND HOME MEDICAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-543-0004
Mailing Address - Street 1:301 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4900
Mailing Address - Country:US
Mailing Address - Phone:631-543-0004
Mailing Address - Fax:631-864-5428
Practice Address - Street 1:301 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4900
Practice Address - Country:US
Practice Address - Phone:631-543-0004
Practice Address - Fax:631-864-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207QA0505X, 207W00000X, 225100000X
363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY419B6CK121Medicare PIN