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General NPI Number Information
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NPI Number | 1912129404
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Entity Type | Organization
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Legal Business Name | ISLAND ANESTHESIOLOGIST PC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1175 MONTAUK HWY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4939
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Country | US
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Telephone | 631-463-1175
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Fax | 516-420-8800
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Provider Business Mailing Address
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Address Line | 118 BAGATELLA ROAD
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City | MELVILLE
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State | NY
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Zip | 11747
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Country | US
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Telephone | 631-463-1175
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Fax | 516-420-8800
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAUL JOSE MASAKAYAN
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Credential | MD
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Telephone | 631-463-1175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 211412
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License Number State | NY
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