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General NPI Number Information
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NPI Number | 1194831016
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Entity Type | Organization
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Legal Business Name | ISLAND FAMILY MEDICINE PC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 20 UNQUA RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758
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Country | US
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Telephone | 516-799-9700
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Fax | 516-799-0134
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Provider Business Mailing Address
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Address Line | 20 UNQUA RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758
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Country | US
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Telephone | 516-799-9700
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Fax | 516-799-0134
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Authorized Official
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Title or Position | PHYSICIAN PRESIDENT
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Name | DR. ANTHONY A FOTO
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Credential | DO
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Telephone | 516-799-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 208853
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License Number State | NY
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