Provider Demographics
NPI:1962449967
Name:LONG ISLAND HYPERTENSION AND NEPHROLOGY, PLLC
Entity Type:Organization
Organization Name:LONG ISLAND HYPERTENSION AND NEPHROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:U
Authorized Official - Last Name:MAILLOUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-484-6093
Mailing Address - Street 1:50 SEAVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4618
Mailing Address - Country:US
Mailing Address - Phone:516-484-6093
Mailing Address - Fax:516-484-6180
Practice Address - Street 1:50 SEAVIEW BLVD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4618
Practice Address - Country:US
Practice Address - Phone:516-484-6093
Practice Address - Fax:516-484-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW38161OtherMEDICARE GROUP NUMBER