Healthcare Provider Details

I. General information

NPI: 1063641124
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF LONG ISLAND, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 COMMERCE AVE SUITE 4
RIVERHEAD NY
11901-3105
US

IV. Provider business mailing address

6 TECHNOLOGY DR SUITE 100
EAST SETAUKET NY
11733-4079
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-6698
  • Fax: 631-751-5548
Mailing address:
  • Phone: 631-689-6698
  • Fax: 631-751-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: STEPHEN B. GOLDSTEIN
Title or Position: PRACTICE ADMINSTRATOR
Credential:
Phone: 631-689-4166