Basic Information
| Provider Information | |||||||||
| NPI: | 1881997724 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONG ISLAND LAPAROSCOPIC SURGERY,P.L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 BELLE TERRE RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117772316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316890220 | ||||||||
| FaxNumber: | 6316867626 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 BELLE TERRE ROAD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117772316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316890220 | ||||||||
| FaxNumber: | 6316867626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2010 | ||||||||
| LastUpdateDate: | 12/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | AHMAD | ||||||||
| AuthorizedOfficialFirstName: | ARIF | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 6316890220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D, FRCS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 221256 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.