Provider Demographics
NPI:1194869495
Name:ISLAND MEDICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:ISLAND MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICEL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-789-4040
Mailing Address - Street 1:618 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2124
Mailing Address - Country:US
Mailing Address - Phone:631-789-4040
Mailing Address - Fax:631-789-4083
Practice Address - Street 1:618 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2124
Practice Address - Country:US
Practice Address - Phone:631-789-4040
Practice Address - Fax:631-789-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027899OtherBLUE CROSS
NY14645OtherVYTRA
NY8459937OtherAETNA
NY7166538OtherLOCAL 1199
NYAZ00211OtherMDNY
NJ001148OtherHORIZON HEALTHCARE
NY0445851003OtherCIGNA
NYANC129OtherOXFORD
NYANC129OtherOXFORD