Healthcare Provider Details

I. General information

NPI: 1972772614
Provider Name (Legal Business Name): RHEUMATOLOGY ASSOCIATES OF L.I., LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MEDICAL DR
PORT JEFFERSON STA NY
11776-1593
US

IV. Provider business mailing address

315 MIDDLE COUNTRY RD
SMITHTOWN NY
11787-2869
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-4885
  • Fax: 631-928-2944
Mailing address:
  • Phone: 631-360-7778
  • Fax: 631-360-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LYNETTE BYRNES
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 631-360-3796