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General NPI Number Information
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NPI Number | 1932170255
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Entity Type | Organization
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Legal Business Name | LONG ISLAND SURGICAL SPECIALIST, P.C.
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 639 PORT WASHINGTON BLVD
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3733
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Country | US
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Telephone | 516-883-2212
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Fax | 516-767-7064
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Provider Business Mailing Address
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Address Line | 639 PORT WASHINGTON BLVD
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3733
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Country | US
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Telephone | 516-883-2212
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Fax | 516-767-7064
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Authorized Official
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Title or Position | OWNER
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Name | DR. RENATO B BERROYA
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Credential | M.D., F.A.C.S.
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Telephone | 516-883-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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