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General NPI Number Information
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NPI Number | 1487692083
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Entity Type | Organization
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Legal Business Name | ISLAND PRIMARY MEDICAL CARE ASSOCIATES PC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 4625 MERRICK RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758-6010
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Country | US
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Telephone | 516-798-1116
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Fax | 516-798-8530
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Provider Business Mailing Address
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Address Line | PO BOX 9461
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City | UNIONDALE
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State | NY
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Zip | 11555-9461
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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 | PARTNER
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Name | JOSEPH ADIYODY
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Credential |
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Telephone | 516-798-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 166537
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License Number State | NY
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