MEDICARE: LONG ISLAND MINIMALLY INVASIVE SURGERY, 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	199144	NY

General Provider Information

NPI Number	:	1356545867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG ISLAND MINIMALLY INVASIVE SURGERY, P.C.

Provider Business Mailing Address
First Line	:	125 MINEOLA AVE
Second Line	:	SUITE 200
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2023
Country	:	US
Telephone Number	:	516-616-5500
Fax Number	:	888-502-6582

Provider Business Practice Location Address
First Line	:	125 MINEOLA AVE
Second Line	:	SUITE 200
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2023
Country	:	US
Telephone Number	:	516-616-5500
Fax Number	:	888-502-6582

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHAWN GARBER
Credential	:	MD
Telephone Number	:	516-616-5500

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	02/02/2017

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