Healthcare Provider Details

I. General information

NPI: 1902032881
Provider Name (Legal Business Name): HELAINE LARSEN D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST MAIN STREET SUITE A103
BABYLON NY
11702-3023
US

IV. Provider business mailing address

200 WEST MAIN STREET SUITE A104
BABYLONG NY
11702
US

V. Phone/Fax

Practice location:
  • Phone: 631-893-5510
  • Fax: 631-893-5394
Mailing address:
  • Phone: 631-682-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number238001
License Number StateNY

VIII. Authorized Official

Name: DR. HELAINE LARSEN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 631-682-2528