Basic Information
| Provider Information | |||||||||
| NPI: | 1659500106 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONG ISLAND MEDICAL P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 JERICHO TPKE | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117914513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165846400 | ||||||||
| FaxNumber: | 5165846401 | ||||||||
| Practice Location | |||||||||
| Address1: | 237 JERICHO TPKE | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117914513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165846400 | ||||||||
| FaxNumber: | 5165846401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2009 | ||||||||
| LastUpdateDate: | 07/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | KADAM | ||||||||
| AuthorizedOfficialFirstName: | JAYDEEP | ||||||||
| AuthorizedOfficialMiddleName: | SHIVAJI | ||||||||
| AuthorizedOfficialTitleorPosition: | CO PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5165846400 | ||||||||
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| 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 | 207RG0100X | 220299 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 238095 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.