Healthcare Provider Details

I. General information

NPI: 1992738538
Provider Name (Legal Business Name): NEW YORK INSTITUTE OF TECHNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CARLETON AVE
CENTRAL ISLIP NY
11722-4505
US

IV. Provider business mailing address

250 CARLETON AVE
CENTRAL ISLIP NY
11722-4505
US

V. Phone/Fax

Practice location:
  • Phone: 631-348-3254
  • Fax: 631-348-3031
Mailing address:
  • Phone: 631-348-3254
  • Fax: 631-348-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: EDDY CHARLES
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 516-686-4969