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General NPI Number Information
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NPI Number | 1659375632
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Entity Type | Organization
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Legal Business Name | LYNBROOK SC LLC
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 444 MERRICK RD STE 400
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City | LYNBROOK
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State | NY
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Zip | 11563-2400
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Country | US
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Telephone | 516-887-0890
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Fax | 516-887-6219
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Provider Business Mailing Address
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Address Line | 444 MERRICK RD
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City | LYNBROOK
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State | NY
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Zip | 11563
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Country | US
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Telephone | 516-887-0890
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Fax | 516-887-6219
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JAY I RAIFMAN
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Credential |
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Telephone | 516-887-0890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 2907200R
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License Number State | NY
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