Healthcare Provider Details

I. General information

NPI: 1447283585
Provider Name (Legal Business Name): LONG ISLAND INFECTIOUS DISEASE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NEW YORK AVE SUITE 5W
HUNTINGTON NY
11743-2743
US

IV. Provider business mailing address

120 NEW YORK AVE SUITE 5W
HUNTINGTON NY
11743-2743
US

V. Phone/Fax

Practice location:
  • Phone: 631-423-9809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNE C SACKS-BERG
Title or Position: DOCTOR
Credential:
Phone: 631-423-9809