Healthcare Provider Details

I. General information

NPI: 1073669479
Provider Name (Legal Business Name): ISLAND INTERNIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LYNDALE AVE
STATEN ISLAND NY
10312-6131
US

IV. Provider business mailing address

420 LYNDALE AVE
STATEN ISLAND NY
10312-6131
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-5630
  • Fax: 718-967-7099
Mailing address:
  • Phone: 718-967-1700
  • Fax: 718-967-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number179723
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22415
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number171607
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number234484
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number234387
License Number StateNY

VIII. Authorized Official

Name: DR. DONNA SEMINARA
Title or Position: OWNER
Credential: M.D.
Phone: 718-967-1700