Provider Demographics
NPI:1457520140
Name:RHEUMATOLOGY ASSOCIATES OF LONG ISLAND, LLP
Entity Type:Organization
Organization Name:RHEUMATOLOGY ASSOCIATES OF LONG ISLAND, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-360-3796
Mailing Address - Street 1:315 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2869
Mailing Address - Country:US
Mailing Address - Phone:631-360-3796
Mailing Address - Fax:631-360-1546
Practice Address - Street 1:1895 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3031
Practice Address - Country:US
Practice Address - Phone:631-249-9525
Practice Address - Fax:631-420-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02501664Medicaid
NY02501664Medicaid