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General NPI Number Information
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NPI Number | 1962449967
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Entity Type | Organization
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Legal Business Name | LONG ISLAND HYPERTENSION AND NEPHROLOGY, PLLC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 50 SEAVIEW BLVD
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-4618
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Country | US
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Telephone | 516-484-6093
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Fax | 516-484-6180
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Provider Business Mailing Address
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Address Line | 50 SEAVIEW BLVD
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-4618
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Country | US
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Telephone | 516-484-6093
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Fax | 516-484-6180
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. LIONEL U MAILLOUX
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Credential | MD
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Telephone | 516-484-6093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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