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General NPI Number Information
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NPI Number | 1699045468
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Entity Type | Organization
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Legal Business Name | LONG ISLAND BARIATRIC PLLC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 715 ROANOKE AVE
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City | RIVERHEAD
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State | NY
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Zip | 11901-2729
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Country | US
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Telephone | 631-963-4750
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Fax |
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Provider Business Mailing Address
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Address Line | 8 OLD SCHOOLHOUSE RD
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City | MANORVILLE
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State | NY
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Zip | 11949-3069
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Country | US
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Telephone | 631-356-3125
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | PAAYAL P MEHTA
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Credential | M.D.
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Telephone | 631-356-3125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 234672-1
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License Number State | NY
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