Basic Information
| Provider Information | |||||||||
| NPI: | 1477704005 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ISLAND MEDICAL HOUSE DOCTOR PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88 ARKAY DR | ||||||||
| Address2: | |||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117883757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315147600 | ||||||||
| FaxNumber: | 6315147601 | ||||||||
| Practice Location | |||||||||
| Address1: | 88 ARKAY DR | ||||||||
| Address2: | |||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117883757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315147600 | ||||||||
| FaxNumber: | 6315147601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2008 | ||||||||
| LastUpdateDate: | 10/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | FERRARA | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | RALPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6315147600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | NY170935 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.