Healthcare Provider Details

I. General information

NPI: 1861558587
Provider Name (Legal Business Name): ISLAND OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 N VILLAGE AVE SUITE 109
ROCKVILLE CENTRE NY
11570-1078
US

IV. Provider business mailing address

2000 N VILLAGE AVE SUITE 109
ROCKVILLE CENTRE NY
11570-1078
US

V. Phone/Fax

Practice location:
  • Phone: 516-678-4000
  • Fax: 516-678-9573
Mailing address:
  • Phone: 516-678-4000
  • Fax: 516-678-9573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS J TARRICONE
Title or Position: CORPORATE OFFICER
Credential: M.D
Phone: 516-678-4000