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General NPI Number Information
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NPI Number | 1619090818
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CARE OF LONG ISLAND, P.C.
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 227 MOUNT PLEASANT RD
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City | HAUPPAUGE
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State | NY
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Zip | 11788-2709
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Country | US
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Telephone | 631-360-3442
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Fax | 631-360-3317
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Provider Business Mailing Address
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Address Line | 227 MOUNT PLEASANT RD
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City | HAUPPAUGE
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State | NY
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Zip | 11788-2709
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Country | US
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Telephone | 631-360-3442
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Fax | 631-360-3317
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ORLANDO VIC. BAUTISTA
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Credential | M.D.
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Telephone | 631-360-3442
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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 | 147898
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License Number State | NY
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