Provider Demographics
NPI:1902032881
Name:HELAINE LARSEN D.O., P.C.
Entity Type:Organization
Organization Name:HELAINE LARSEN D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-682-2528
Mailing Address - Street 1:200 WEST MAIN STREET
Mailing Address - Street 2:SUITE A104
Mailing Address - City:BABYLONG
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:631-682-2528
Mailing Address - Fax:
Practice Address - Street 1:200 WEST MAIN STREET
Practice Address - Street 2:SUITE A103
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3023
Practice Address - Country:US
Practice Address - Phone:631-893-5510
Practice Address - Fax:631-893-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty