Provider Demographics
NPI:1821121179
Name:MEDICAL ONCOLOGY ASSOCIATES OF LONG ISLAND PC
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY ASSOCIATES OF LONG ISLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:I
Authorized Official - Last Name:KAPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-921-5533
Mailing Address - Street 1:40 CROSSWAYS PARK DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2036
Mailing Address - Country:US
Mailing Address - Phone:516-921-5533
Mailing Address - Fax:516-364-4080
Practice Address - Street 1:40 CROSSWAYS PARK DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2036
Practice Address - Country:US
Practice Address - Phone:516-921-5533
Practice Address - Fax:516-364-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0300200001OtherDME GROUP
NY0300200001Medicare NSC
W05761Medicare PIN
NYW05761Medicare UPIN