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General NPI Number Information
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NPI Number | 1972678183
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL PRACTICE OF LONG ISLAND P.C.
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 221 BROADWAY SUITE 207
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City | AMITYVILLE
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State | NY
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Zip | 11701-2780
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Country | US
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Telephone | 631-786-5692
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Fax | 631-368-4891
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Provider Business Mailing Address
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Address Line | PO BOX 230
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City | MASSAPEQUA
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State | NY
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Zip | 11758-0230
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Country | US
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Telephone | 631-786-5692
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Fax | 631-368-4891
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT POLOFSKY
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Credential | D.O.
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Telephone | 631-786-5692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 168859
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License Number State | NY
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