Healthcare Provider Details

I. General information

NPI: 1548323074
Provider Name (Legal Business Name): SYOSSET OPHTHALMOLOGY ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BURKE LN
SYOSSET NY
11791-3931
US

IV. Provider business mailing address

4 BURKE LN
SYOSSET NY
11791-3931
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-1155
  • Fax: 516-921-1389
Mailing address:
  • Phone: 516-921-1155
  • Fax: 516-921-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY LLOYD WILLIG
Title or Position: MEMBER
Credential: MD
Phone: 516-921-1155