Basic Information
| Provider Information | |||||||||
| NPI: | 1245415322 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VASCULAR ASSOCIATES OF LONG ISLAND, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 TECHNOLOGY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117334068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312468289 | ||||||||
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| Address1: | 4 TECHNOLOGY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117334068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312468289 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2008 | ||||||||
| LastUpdateDate: | 06/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | LASNIER | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6313314540 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.