Provider Demographics
NPI:1194823914
Name:ORTHOPEDIC ASSOCIATES OF LONG ISLAND, LLP
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF LONG ISLAND, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GMYTRASIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-689-6698
Mailing Address - Street 1:6 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4079
Mailing Address - Country:US
Mailing Address - Phone:631-689-6698
Mailing Address - Fax:631-751-5548
Practice Address - Street 1:6 TECHNOLOGY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4079
Practice Address - Country:US
Practice Address - Phone:631-689-6698
Practice Address - Fax:631-751-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWX0281Medicare PIN
NY6266750001Medicare NSC