=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215824891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONG ISLAND MEDICAL CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2025
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 OLD COUNTRY RD STE 170
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-271-9151
-----------------------------------------------------
Fax | 631-271-9155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 QUEENS ST UNIT 161
-----------------------------------------------------
City | SYOSSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11791-7407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-271-9151
-----------------------------------------------------
Fax | 631-271-9155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALEXEY YANILSHTEIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 631-271-9151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------