Provider Demographics
NPI:1962040618
Name:LONG ISLAND INTEGRATIVE MEDICAL WELLNESS PLLC
Entity Type:Organization
Organization Name:LONG ISLAND INTEGRATIVE MEDICAL WELLNESS PLLC
Other - Org Name:LONG ISLAND INTEGRATIVE HEALTH PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSAMMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-548-7061
Mailing Address - Street 1:1611 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4540
Mailing Address - Country:US
Mailing Address - Phone:516-548-7061
Mailing Address - Fax:516-548-7445
Practice Address - Street 1:1611 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4540
Practice Address - Country:US
Practice Address - Phone:516-548-7061
Practice Address - Fax:516-548-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty