1609099027 NPI number — ISLAND MUSCULOSKELETAL CARE, M.D., P.C.

Table of content: (NPI 1609099027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609099027 NPI number — ISLAND MUSCULOSKELETAL CARE, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISLAND MUSCULOSKELETAL CARE, M.D., P.C.
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:
1609099027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1512 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEWLETT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11557-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-374-6838
Provider Business Mailing Address Fax Number:
516-374-2362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 BOYLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELDEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11784-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-451-6796
Provider Business Practice Location Address Fax Number:
516-374-2362
Provider Enumeration Date:
04/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHIMATO
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
516-374-6838

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207X00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208100000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084N0400X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085R0202X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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