Healthcare Provider Details

I. General information

NPI: 1962496968
Provider Name (Legal Business Name): LONG ISLAND DIABETES & ENDOCRINOLOGY ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 DEER PARK AVE
BABYLON NY
11702
US

IV. Provider business mailing address

213 HALLOCK RD SUITE 6
STONY BROOK NY
11790
US

V. Phone/Fax

Practice location:
  • Phone: 631-941-1000
  • Fax:
Mailing address:
  • Phone: 631-941-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA O'BRIEN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 631-941-1000