Provider Demographics
NPI:1750414736
Name:EASTERN INFECTIOUS DISEASE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:EASTERN INFECTIOUS DISEASE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-689-5400
Mailing Address - Street 1:14 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3472
Mailing Address - Country:US
Mailing Address - Phone:631-689-5400
Mailing Address - Fax:631-689-8247
Practice Address - Street 1:14 TECHNOLOGY DR
Practice Address - Street 2:SUITE 10
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3472
Practice Address - Country:US
Practice Address - Phone:631-689-5400
Practice Address - Fax:631-689-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW6L131Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER