Provider Demographics
NPI:1306098991
Name:LONG ISLAND PHYSICAL MEDICINE AND REHAB I, P.C.
Entity type:Organization
Organization Name:LONG ISLAND PHYSICAL MEDICINE AND REHAB I, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-579-6700
Mailing Address - Street 1:575 UNDERHILL BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-933-3300
Mailing Address - Fax:516-933-1039
Practice Address - Street 1:380 N BROADWAY STE 307
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2109
Practice Address - Country:US
Practice Address - Phone:516-933-3300
Practice Address - Fax:516-933-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196772-1208100000X, 2081P2900X
NY168280-12081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty