Provider Demographics
NPI:1780983395
Name:ADVANCED LAPAROSCOPIC BARIATRIC AND GENERAL SURGERY
Entity type:Organization
Organization Name:ADVANCED LAPAROSCOPIC BARIATRIC AND GENERAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARIF
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-689-0220
Mailing Address - Street 1:625 BELLE TERRE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2316
Mailing Address - Country:US
Mailing Address - Phone:631-689-0220
Mailing Address - Fax:
Practice Address - Street 1:625 BELLE TERRE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2316
Practice Address - Country:US
Practice Address - Phone:631-689-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2496301208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty