Provider Demographics
NPI:1861558587
Name:ISLAND OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:ISLAND OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TARRICONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-678-4000
Mailing Address - Street 1:2000 N VILLAGE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1078
Mailing Address - Country:US
Mailing Address - Phone:516-678-4000
Mailing Address - Fax:516-678-9573
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-678-4000
Practice Address - Fax:516-678-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty