Healthcare Provider Details

I. General information

NPI: 1306196936
Provider Name (Legal Business Name): PRIMARY MEDICAL ASSOCIATES OF LONG ISLAND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SUNNYSIDE BLVD STE E
PLAINVIEW NY
11803-1517
US

IV. Provider business mailing address

54 SUNNYSIDE BLVD STE E
PLAINVIEW NY
11803-1517
US

V. Phone/Fax

Practice location:
  • Phone: 516-506-7776
  • Fax: 516-719-0708
Mailing address:
  • Phone: 516-506-7776
  • Fax: 516-719-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number260076
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier33D2057234
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerCLIA

VIII. Authorized Official

Name: DR. NATALIA LEVINSKAYA
Title or Position: ATTENDING PHYSICIAN
Credential: D.O.
Phone: 516-506-7776