MEDICARE: CARING LONG ISLAND MEDICAL P.C.

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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	187333	NY

General Provider Information

NPI Number	:	1407295108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARING LONG ISLAND MEDICAL P.C.

Provider Business Mailing Address
First Line	:	90 WILDWOOD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1223
Country	:	US
Telephone Number	:	516-796-4433
Fax Number	:	516-796-4288

Provider Business Practice Location Address
First Line	:	90 WILDWOOD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1223
Country	:	US
Telephone Number	:	516-796-4433
Fax Number	:	516-796-4288

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KOUROSH ASHOURZADEH
Credential	:	D.O.
Telephone Number	:	516-796-4433

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	06/17/2013

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