Healthcare Provider Details

I. General information

NPI: 1699892976
Provider Name (Legal Business Name): LONG ISLAND EYE SURGEONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 NORTHERN BLVD SUITE 208
MANHASSET NY
11030-3502
US

IV. Provider business mailing address

2110 NORTHERN BLVD SUITE 208
MANHASSET NY
11030-3502
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-5113
  • Fax: 516-365-2817
Mailing address:
  • Phone: 516-627-5113
  • Fax: 516-365-2817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number109382
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACEY A ORTIZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 516-627-5113