Healthcare Provider Details

I. General information

NPI: 1013121409
Provider Name (Legal Business Name): L.I. OFFICE-BASED SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OLD COUNTRY RD SUITE 300
PLAINVIEW NY
11803-4942
US

IV. Provider business mailing address

875 OLD COUNTRY RD SUITE 300
PLAINVIEW NY
11803-4942
US

V. Phone/Fax

Practice location:
  • Phone: 516-433-2424
  • Fax: 516-433-1065
Mailing address:
  • Phone: 516-433-2424
  • Fax: 516-433-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DOMENICO VALENTE
Title or Position: OWNER
Credential: M.D.
Phone: 516-433-2424