MEDICARE: LONG ISLAND FAMILY MEDICAL GROUP PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1447312988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG ISLAND FAMILY MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	160 MIDDLE ROAD
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-3126
Country	:	US
Telephone Number	:	531-589-4747
Fax Number	:	631-589-4793

Provider Business Practice Location Address
First Line	:	160 MIDDLE ROAD
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-3126
Country	:	US
Telephone Number	:	531-589-4747
Fax Number	:	631-589-4793

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. MARGARET M SIMAT
Credential	:
Telephone Number	:	631-589-8324

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	11/23/2007

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