Provider Demographics
NPI:1851062756
Name:LONG ISLAND NP IN ADULT HEALTH PLLC
Entity Type:Organization
Organization Name:LONG ISLAND NP IN ADULT HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIVARANJANI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAMOORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, ANP-C, PMHNP-BC
Authorized Official - Phone:631-730-7582
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-0074
Mailing Address - Country:US
Mailing Address - Phone:631-730-7582
Mailing Address - Fax:
Practice Address - Street 1:99 GAZEBO LN
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1664
Practice Address - Country:US
Practice Address - Phone:631-730-7382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care