MEDICARE: ISLAND MEDICAL ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	027899	OTHER	NY	BLUE CROSS
2	14645	OTHER	NY	VYTRA
3	8459937	OTHER	NY	AETNA
4	7166538	OTHER	NY	LOCAL 1199
5	AZ00211	OTHER	NY	MDNY
6	001148	OTHER	NJ	HORIZON HEALTHCARE
7	0445851003	OTHER	NY	CIGNA
8	ANC129	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1194869495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND MEDICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	618 BROADWAY
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-2124
Country	:	US
Telephone Number	:	631-789-4040
Fax Number	:	631-789-4083

Provider Business Practice Location Address
First Line	:	618 BROADWAY
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-2124
Country	:	US
Telephone Number	:	631-789-4040
Fax Number	:	631-789-4083

Authorized Official
Title or Position	:	OFFICEL MANAGER
Name	:	MRS. KAREN MARTEN
Credential	:
Telephone Number	:	631-789-4040

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	08/22/2020

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Directions to “ISLAND MEDICAL ASSOCIATES, P.C. ” Practice Location

Language	Start Address	Practice Location

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