Provider Demographics
NPI:1235702028
Name:LONG ISLAND INTEGRATED MEDICAL SERVICES PC
Entity type:Organization
Organization Name:LONG ISLAND INTEGRATED MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-870-1600
Mailing Address - Street 1:191 BETHPAGE SWEET HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1342
Mailing Address - Country:US
Mailing Address - Phone:516-870-1600
Mailing Address - Fax:
Practice Address - Street 1:191 BETHPAGE SWEET HOLLOW RD
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1342
Practice Address - Country:US
Practice Address - Phone:516-870-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy