Healthcare Provider Details

I. General information

NPI: 1053517557
Provider Name (Legal Business Name): LONG ISLAND SPECIALIST PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13304 41ST AVE # 1A
FLUSHING NY
11355-3629
US

IV. Provider business mailing address

13304 41ST AVE # 1A
FLUSHING NY
11355-3629
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-7265
  • Fax: 718-353-7267
Mailing address:
  • Phone: 718-353-7265
  • Fax: 718-353-7267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: YIPING GENG
Title or Position: PRESIDENT
Credential: MD
Phone: 718-353-7265