Provider Demographics
NPI:1811220452
Name:LYNBROOK MEDICAL DIAGNOSTIC ULTRASOUND
Entity Type:Organization
Organization Name:LYNBROOK MEDICAL DIAGNOSTIC ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-498-1394
Mailing Address - Street 1:875 SUNRISE HWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:875 SUNRISE HWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2800
Practice Address - Country:US
Practice Address - Phone:516-872-7001
Practice Address - Fax:516-872-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty