Healthcare Provider Details

I. General information

NPI: 1992089296
Provider Name (Legal Business Name): LONG ISLAND GASTROENTEROLOGY & LIVER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 OLD COUNTRY ROAD SUITE 8
PLAINVIEW NY
11803
US

IV. Provider business mailing address

1181 OLD COUNTRY ROAD SUITE 8
PLAINVIEW NY
11803
US

V. Phone/Fax

Practice location:
  • Phone: 516-277-2630
  • Fax: 516-277-2629
Mailing address:
  • Phone: 516-277-2630
  • Fax: 516-277-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number236009
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name: LEIH LIEBER
Title or Position: OWNER
Credential: MD
Phone: 516-277-2630