Healthcare Provider Details

I. General information

NPI: 1871967570
Provider Name (Legal Business Name): LONG ISLAND INTEGRATIVE MEDICINE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FULTON STREET
FARMINGDALE NY
11735
US

IV. Provider business mailing address

101 FULTON STREET
FARMINGDALE NY
11735
US

V. Phone/Fax

Practice location:
  • Phone: 516-428-2339
  • Fax: 516-516-5865
Mailing address:
  • Phone: 516-428-2339
  • Fax: 516-516-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number197645-1
License Number StateNY

VIII. Authorized Official

Name: DR. MARK L SCHWARTZ
Title or Position: PRESIDENT
Credential: D.O.
Phone: 516-428-2339