Provider Demographics
NPI:1992815641
Name:ORTHOPAEDIC EXCELLENCE OF LONG ISLAND, PC
Entity type:Organization
Organization Name:ORTHOPAEDIC EXCELLENCE OF LONG ISLAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-678-2232
Mailing Address - Street 1:2000 N VILLAGE AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1078
Mailing Address - Country:US
Mailing Address - Phone:516-678-2232
Mailing Address - Fax:516-678-8405
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-678-2232
Practice Address - Fax:516-678-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11347Medicare UPIN
NYA65111Medicare UPIN
NYP46571Medicare ID - Type Unspecified
NYOF291Medicare ID - Type Unspecified
NY5691LMedicare ID - Type Unspecified
NYP39171Medicare ID - Type Unspecified
NY56A341Medicare ID - Type Unspecified
NY0598690001Medicare NSC
NYB15940Medicare UPIN
NYT51194Medicare UPIN
NYG24352Medicare UPIN
NY96D851Medicare ID - Type Unspecified
NY82P171Medicare ID - Type Unspecified
NYT71190Medicare UPIN
NY520451Medicare ID - Type Unspecified