Provider Demographics
NPI:1730230582
Name:LONG ISLAND PEDIATRICS OF GARDEN CITY
Entity type:Organization
Organization Name:LONG ISLAND PEDIATRICS OF GARDEN CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:ACCETTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:516-488-8830
Mailing Address - Street 1:50 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3909
Mailing Address - Country:US
Mailing Address - Phone:516-488-8830
Mailing Address - Fax:516-488-8832
Practice Address - Street 1:50 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3909
Practice Address - Country:US
Practice Address - Phone:516-488-8830
Practice Address - Fax:516-488-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200571208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty