Provider Demographics
NPI:1134322001
Name:LONG ISLAND PODIATRY ASSOCIATES, PC
Entity type:Organization
Organization Name:LONG ISLAND PODIATRY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ABRAHAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-822-9595
Mailing Address - Street 1:100 MANETTO HILL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1311
Mailing Address - Country:US
Mailing Address - Phone:516-822-9595
Mailing Address - Fax:516-822-9582
Practice Address - Street 1:100 MANETTO HILL RD STE 103
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1311
Practice Address - Country:US
Practice Address - Phone:516-822-9595
Practice Address - Fax:516-822-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004608213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT92849Medicare UPIN