Provider Demographics
NPI:1912129404
Name:ISLAND ANESTHESIOLOGIST PC
Entity Type:Organization
Organization Name:ISLAND ANESTHESIOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:MASAKAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-463-1175
Mailing Address - Street 1:118 BAGATELLA ROAD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:631-463-1175
Mailing Address - Fax:516-420-8800
Practice Address - Street 1:1175 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4939
Practice Address - Country:US
Practice Address - Phone:631-463-1175
Practice Address - Fax:516-420-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211412207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBM4638663OtherDEA #
NYG16185Medicare UPIN
NY3Y8302Medicare ID - Type Unspecified