Healthcare Provider Details

I. General information

NPI: 1134322001
Provider Name (Legal Business Name): LONG ISLAND PODIATRY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD STE 103
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

100 MANETTO HILL RD STE 103
PLAINVIEW NY
11803-1311
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-9595
  • Fax: 516-822-9582
Mailing address:
  • Phone: 516-822-9595
  • Fax: 516-822-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004608
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. HAL F ABRAHAMSON
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 516-822-9595