Provider Demographics
NPI:1336341148
Name:LONG ISLAND THORACIC SURGERY P.C.
Entity Type:Organization
Organization Name:LONG ISLAND THORACIC SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSOVOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-255-5010
Mailing Address - Street 1:444 MERRICK RD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2460
Mailing Address - Country:US
Mailing Address - Phone:516-255-5010
Mailing Address - Fax:516-255-5020
Practice Address - Street 1:444 MERRICK RD
Practice Address - Street 2:SUITE 380
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2460
Practice Address - Country:US
Practice Address - Phone:516-255-5010
Practice Address - Fax:516-255-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYW4X051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01280588Medicaid
NY02170116Medicaid
NYW4X051Medicare ID - Type Unspecified
NY17G961Medicare ID - Type Unspecified
NYH44342Medicare UPIN
NY02170116Medicaid
NY928491Medicare ID - Type Unspecified