Provider Demographics
NPI:1942532676
Name:307 LONG ISLAND MEDICAL P.C
Entity Type:Organization
Organization Name:307 LONG ISLAND MEDICAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAGANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-487-5858
Mailing Address - Street 1:307 EAST SHORE ROAD, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86-75 MIDLAND PARKWAY
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11423
Practice Address - Country:US
Practice Address - Phone:516-487-5858
Practice Address - Fax:516-487-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty