Provider Demographics
NPI:1427170216
Name:MID ISLAND ALLERGY GROUP, P.C.
Entity type:Organization
Organization Name:MID ISLAND ALLERGY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-938-7676
Mailing Address - Street 1:1171 OLD COUNTRY RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5022
Mailing Address - Country:US
Mailing Address - Phone:516-938-7676
Mailing Address - Fax:516-938-7718
Practice Address - Street 1:1171 OLD COUNTRY RD
Practice Address - Street 2:SUITE #5
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5022
Practice Address - Country:US
Practice Address - Phone:516-938-7676
Practice Address - Fax:516-938-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136160207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100026834Medicare PIN