Provider Demographics
NPI:1922017797
Name:LONG ISLAND MEDICAL & COSMETIC
Entity Type:Organization
Organization Name:LONG ISLAND MEDICAL & COSMETIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:SHERER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-271-2769
Mailing Address - Street 1:755 PARK AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3975
Mailing Address - Country:US
Mailing Address - Phone:631-271-2769
Mailing Address - Fax:631-271-1730
Practice Address - Street 1:755 PARK AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3975
Practice Address - Country:US
Practice Address - Phone:631-271-2769
Practice Address - Fax:631-271-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2108421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWLQ411Medicare PIN