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Organization
ISLAND MEDICAL GROUP, PC
Active
Organization
ISLAND MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN BRENNER-SMITH (BILLING MANAGER)
(516) 731-7770
Entity
Organization
Contact information
Practice address
4277 HEMPSTEAD TPKE, SUITE 209, BETHPAGE, NY 11714-5709
(516) 731-7770
(516) 731-7052
Mailing address
4277 HEMPSTEAD TPKE, SUITE 209, BETHPAGE, NY 11714-5709
(516) 731-7770
(516) 731-7052
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RR0500X
Rheumatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00100918
—
NY
Enumeration date
08/19/2006
Last updated
02/04/2009
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