Basic Information
| Provider Information | |||||||||
| NPI: | 1255741153 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBOR VIEW MEDICAL SERVICES, P.C. | ||||||||
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| OtherOrganizationName: | VASCULAR ASSOCIATES OF LONG ISLAND | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 TECHNOLOGY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117334080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312468289 | ||||||||
| FaxNumber: | 6312468294 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 TECHNOLOGY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117334080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316867890 | ||||||||
| FaxNumber: | 6312468294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2014 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | FARO | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6314762866 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CMO | ||||||||
| NPICertificationDate: | |||||||||
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.