Provider Demographics
NPI:1841223369
Name:LONG ISLAND FAMILY MEDICAL GROUP PC
Entity Type:Organization
Organization Name:LONG ISLAND FAMILY MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-589-8324
Mailing Address - Street 1:631 LAKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST. JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780
Mailing Address - Country:US
Mailing Address - Phone:631-589-8324
Mailing Address - Fax:631-589-4793
Practice Address - Street 1:631 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ST JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780
Practice Address - Country:US
Practice Address - Phone:631-878-7134
Practice Address - Fax:631-878-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW43121Medicare PIN
NYW43121Medicare UPIN