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General NPI Number Information
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NPI Number | 1134634645
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Entity Type | Organization
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Legal Business Name | LONG ISLAND PHYSICIAN AFFILIATES, PLLC
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 635 BELLE TERRE RD STE 209
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1935
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Country | US
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Telephone | 631-503-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 333 ROUTE 25A STE 225
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City | ROCKY POINT
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State | NY
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Zip | 11778-8802
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Country | US
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Telephone | 631-503-1400
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | JOHN VON LINTIG
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Credential |
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Telephone | 631-503-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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