Basic Information
| Provider Information | |||||||||
| NPI: | 1134634645 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONG ISLAND PHYSICIAN AFFILIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 ROUTE 25A STE 225 | ||||||||
| Address2: | |||||||||
| City: | ROCKY POINT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117788802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315031400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 635 BELLE TERRE RD STE 209 | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315031400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2017 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | VON LINTIG | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6315031400 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LONG ISLAND PHYSICIAN ASSOCIATES, PLLC | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.