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General NPI Number Information
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NPI Number | 1336341148
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Entity Type | Organization
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Legal Business Name | LONG ISLAND THORACIC SURGERY P.C.
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 444 MERRICK RD SUITE 380
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City | LYNBROOK
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State | NY
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Zip | 11563-2460
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Country | US
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Telephone | 516-255-5010
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Fax | 516-255-5020
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Provider Business Mailing Address
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Address Line | 444 MERRICK RD SUITE 380
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City | LYNBROOK
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State | NY
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Zip | 11563-2460
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Country | US
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Telephone | 516-255-5010
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Fax | 516-255-5020
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LAURA KOSOVOI
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Credential |
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Telephone | 516-255-5010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | W4X051
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License Number State | NY
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