Healthcare Provider Details

I. General information

NPI: 1619237807
Provider Name (Legal Business Name): INFECTIOUS DISEASE CONSULTANT OF LONG ISLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NORTHERN BLVD SUITE 300
MANHASSET NY
11030-3037
US

IV. Provider business mailing address

PO BOX 530
JERICHO NY
11753-0530
US

V. Phone/Fax

Practice location:
  • Phone: 516-404-0493
  • Fax:
Mailing address:
  • Phone: 516-404-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number222363
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: YELENA MARKOVSKAYA
Title or Position: CEO / OWNER
Credential: MD
Phone: 516-404-0493