Organization
LONG ISLAND MEDICAL OF AMITYVILLE PC
Active
Other names
long island medical of amityville pc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAAELDIN F MOAWAD MD (MEDICAL DIRECTOR)
(631) 504-5755
Entity
Organization
Contact information
Practice address
116 BROADWAY, AMITYVILLE, NY 11701-2797
(631) 504-5755
(631) 504-5756
Mailing address
116 BROADWAY, AMITYVILLE, NY 11701-2797
(631) 504-5755
(631) 504-5756
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
232607
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02647309
—
NY
Enumeration date
11/09/2017
Last updated
11/09/2017
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