Provider Demographics
NPI:1841572096
Name:LONG ISLAND MEDICAL PRACTICE LLC
Entity Type:Organization
Organization Name:LONG ISLAND MEDICAL PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-503-7032
Mailing Address - Street 1:41 GREENTREE CIR
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1510
Mailing Address - Country:US
Mailing Address - Phone:516-503-7032
Mailing Address - Fax:516-338-5324
Practice Address - Street 1:41 GREENTREE CIR
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1510
Practice Address - Country:US
Practice Address - Phone:516-503-7032
Practice Address - Fax:516-338-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty