=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659500106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONG ISLAND MEDICAL P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2009
-----------------------------------------------------
Last Update Date | 07/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 237 JERICHO TPKE
-----------------------------------------------------
City | SYOSSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11791-4513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-584-6400
-----------------------------------------------------
Fax | 516-584-6401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 237 JERICHO TPKE
-----------------------------------------------------
City | SYOSSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11791-4513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-584-6400
-----------------------------------------------------
Fax | 516-584-6401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO PRESIDENT
-----------------------------------------------------
Name | DR. JAYDEEP SHIVAJI KADAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 516-584-6400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 220299
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 238095
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------