Healthcare Provider Details

I. General information

NPI: 1841485273
Provider Name (Legal Business Name): LONG ISLAND FERTILITY & ENDOCRINOLOGY IVF ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MARCUS AVE SUITE N216
NEW HYDE PARK NY
11042-1011
US

IV. Provider business mailing address

2001 MARCUS AVE SUITE N216
NEW HYDE PARK NY
11042-1011
US

V. Phone/Fax

Practice location:
  • Phone: 516-358-6363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE RAVECH
Title or Position: VICE PRESIDENT, MANAGED CARE
Credential:
Phone: 860-678-3428