Healthcare Provider Details

I. General information

NPI: 1730385717
Provider Name (Legal Business Name): LONG ISLAND INFECTIOUS DISEASE ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 03/13/2008
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 SACKS-BERG
Title or Position: DOCTOR
Credential: MD
Phone: 631-331-4540