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General NPI Number Information
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NPI Number | 1154546653
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Entity Type | Organization
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Legal Business Name | GYNECOLOGIC SPECIALISTS OF LONG ISLAND LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 OLD COUNTRY RD SUITE 201
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City | MINEOLA
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State | NY
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Zip | 11501
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Country | US
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Telephone | 516-747-4406
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Fax | 516-747-4456
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Provider Business Mailing Address
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Address Line | 375 N BROADWAY SUITE LL2
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City | JERICHO
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State | NY
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Zip | 11753
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TERRY SPECTUR
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Credential |
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Telephone | 516-433-5018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State | NY
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