Healthcare Provider Details

I. General information

NPI: 1699392357
Provider Name (Legal Business Name): LONG ISLAND PEDIATRICS OF PATCHOGUE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E MAIN ST STE 109
PATCHOGUE NY
11772-3121
US

IV. Provider business mailing address

475 E MAIN ST STE 109
PATCHOGUE NY
11772-3121
US

V. Phone/Fax

Practice location:
  • Phone: 631-333-9800
  • Fax:
Mailing address:
  • Phone: 631-333-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. RAMON E FERRAND
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 631-333-9800