1114146073 NPI number — MID ISLAND EYE PHYSICIANS & SURGEONS PC

Table of content: (NPI 1114146073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114146073 NPI number — MID ISLAND EYE PHYSICIANS & SURGEONS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID ISLAND EYE PHYSICIANS & SURGEONS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114146073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4277 HEMPSTEAD TPKE
Provider Second Line Business Mailing Address:
#109
Provider Business Mailing Address City Name:
BETHPAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-796-4030
Provider Business Mailing Address Fax Number:
516-796-5134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4277 HEMPSTEAD TPKE
Provider Second Line Business Practice Location Address:
#109
Provider Business Practice Location Address City Name:
BETHPAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-796-4030
Provider Business Practice Location Address Fax Number:
516-796-5134
Provider Enumeration Date:
04/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KARL
Authorized Official First Name:
TED
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER 26 PERCENT
Authorized Official Telephone Number:
516-796-4030

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  138520 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 146480 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 224064 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 183193 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 178691 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 191081 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)