Provider Demographics
NPI:1962496968
Name:LONG ISLAND DIABETES & ENDOCRINOLOGY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:LONG ISLAND DIABETES & ENDOCRINOLOGY ASSOCIATES, LLP
Other - Org Name:LONG ISLAND DIABETES & ENDOCRINOLOGY, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-941-1000
Mailing Address - Street 1:213 HALLOCK RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-941-1000
Mailing Address - Fax:
Practice Address - Street 1:421 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702
Practice Address - Country:US
Practice Address - Phone:631-941-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH02006Medicare UPIN
16B331Medicare ID - Type Unspecified