Basic Information
| Provider Information | |||||||||
| NPI: | 1003161571 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONG ISLAND ALLERGY AND ASTHMA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 NESCONSET HWY BLDG 17A | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117902563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317516262 | ||||||||
| FaxNumber: | 6317516268 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 NESCONSET HWY BLDG 17A | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117902563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317516262 | ||||||||
| FaxNumber: | 6317516268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2012 | ||||||||
| LastUpdateDate: | 10/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | CYMERMAN | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6317516262 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 161005 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.