Healthcare Provider Details

I. General information

NPI: 1053461665
Provider Name (Legal Business Name): LONG ISLAND FAMILY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ROUTE 25A
MILLER PLACE NY
11764-2649
US

IV. Provider business mailing address

765 ROUTE 25A
MILLER PLACE NY
11764-2649
US

V. Phone/Fax

Practice location:
  • Phone: 631-589-4747
  • Fax:
Mailing address:
  • Phone: 631-589-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARGARET M SIMAT
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 631-589-8324