Provider Demographics
NPI:1528161171
Name:LONG ISLAND ANESTHESIOLOGISTS, PLLC
Entity type:Organization
Organization Name:LONG ISLAND ANESTHESIOLOGISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE COMMITTEE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-235-8924
Mailing Address - Street 1:PO BOX 95000 LB# 7595
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-7595
Mailing Address - Country:US
Mailing Address - Phone:888-235-8924
Mailing Address - Fax:551-230-6201
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:GOOD SAMARITON HOSPITAL
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:888-235-8924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856239Medicaid
X31582Medicare UPIN
NYWX0451Medicare ID - Type Unspecified