Provider Demographics
NPI:1790845097
Name:NORTH FORK ENDOCRINOLOGY PC
Entity Type:Organization
Organization Name:NORTH FORK ENDOCRINOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-369-3333
Mailing Address - Street 1:1149 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2057
Mailing Address - Country:US
Mailing Address - Phone:631-369-3333
Mailing Address - Fax:631-369-9568
Practice Address - Street 1:1149 OLD COUNTRY RD
Practice Address - Street 2:SUITE C1
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2057
Practice Address - Country:US
Practice Address - Phone:631-369-3333
Practice Address - Fax:631-369-9568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204491207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG48820Medicare UPIN