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General NPI Number Information
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NPI Number | 1467589861
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Entity Type | Organization
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Legal Business Name | LONG ISLAND PEDIATRIC OPHTHALMOLOGY & STRABISMUS, P.C.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 60 N COUNTRY RD 301
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2188
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Country | US
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Telephone | 631-474-4200
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Fax | 631-474-4202
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Provider Business Mailing Address
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Address Line | 60 N COUNTRY RD 301
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2188
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Country | US
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Telephone | 631-474-4200
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Fax | 631-474-4202
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAURY ALAN MARMOR
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Credential | M.D.
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Telephone | 631-474-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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