Organization
LONG ISLAND FERTILITY, PLLC
Active
Organization
LONG ISLAND FERTILITY, PLLC
Active
Other names
Long Island IVF
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE RAVECH MPA (VICE PRESIDENT, MANAGED CARE)
(860) 678-3428
Entity
Organization
Contact information
Practice address
8 CORPORATE CENTER DR, SUITE 101, MELVILLE, NY 11747-3193
(631) 752-0606
(631) 331-1332
Mailing address
8 CORPORATE CENTER DR, SUITE 101, MELVILLE, NY 11747-3193
(631) 752-0606
(631) 331-1332
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33D1081165
CLIA
NY
Enumeration date
10/19/2011
Last updated
10/19/2011
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