Healthcare Provider Details

I. General information

NPI: 1720371248
Provider Name (Legal Business Name): LONG ISLAND HOME MEDICAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAPLE AVE
SMITHTOWN NY
11787-4900
US

IV. Provider business mailing address

301 MAPLE AVE
SMITHTOWN NY
11787-4900
US

V. Phone/Fax

Practice location:
  • Phone: 631-543-0004
  • Fax: 631-864-5428
Mailing address:
  • Phone: 631-543-0004
  • Fax: 631-864-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY ABELA
Title or Position: BILLING SPECIALIST
Credential:
Phone: 631-543-0004