Basic Information
| Provider Information | |||||||||
| NPI: | 1952420903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ISLAND NEONATOLOGY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 272 | ||||||||
| Address2: | |||||||||
| City: | EAST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117300272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312241878 | ||||||||
| FaxNumber: | 6312247963 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 BELLE TERRE RD | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314742000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MONTI | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6312241878 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.