MEDICARE: LONG ISLAND ENT ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1285605436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG ISLAND ENT ASSOCIATES

Provider Business Mailing Address
First Line	:	875 OLD COUNTRY RD
Second Line	:	SUITE 200
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4942
Country	:	US
Telephone Number	:	516-931-5552
Fax Number	:	516-931-6563

Provider Business Practice Location Address
First Line	:	875 OLD COUNTRY RD
Second Line	:	SUITE 200
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4942
Country	:	US
Telephone Number	:	516-931-5552
Fax Number	:	516-931-6563

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAY SCOTT YOUNGERMAN
Credential	:	M.D.
Telephone Number	:	516-931-5552

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	08/22/2020

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