MEDICARE: ISLAND MEDICINE, PLLC

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	261Q00000X	Clinic/Center	230316	NY

General Provider Information

NPI Number	:	1477724615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	2 SILLS CT
Second Line	:
City	:	CENTERPORT
State	:	NY
Zip	:	11721-1634
Country	:	US
Telephone Number	:	631-757-9500
Fax Number	:	631-757-2325

Provider Business Practice Location Address
First Line	:	2 SILLS CT
Second Line	:
City	:	CENTERPORT
State	:	NY
Zip	:	11721-1634
Country	:	US
Telephone Number	:	631-757-9500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PATRICK B. BURNS
Credential	:	M.D.
Telephone Number	:	631-757-9500

Provider Enumeration Date	:	03/16/2008
Last Update Date	:	11/06/2008

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