Provider Demographics
NPI:1447283585
Name:LONG ISLAND INFECTIOUS DISEASE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:LONG ISLAND INFECTIOUS DISEASE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SACKS-BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-423-9809
Mailing Address - Street 1:120 NEW YORK AVE
Mailing Address - Street 2:SUITE 5W
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 NEW YORK AVE
Practice Address - Street 2:SUITE 5W
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2743
Practice Address - Country:US
Practice Address - Phone:631-423-9809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWAA481Medicare ID - Type Unspecified