NPIMap

Organization Active NPI

Long Island Medical of Amityville PC

  • Pediatrics Physician
  • Amityville, NY
National Provider Identifier
1013420306
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
232607 Issued in NY
Legal business name
LONG ISLAND MEDICAL OF AMITYVILLE PC
Practice address
116 Broadway
Amityville, NY 11701-2797
Phone
(631) 504-5755
Fax
(631) 504-5756
NPI assigned
Nov 9, 2017
Last updated
Nov 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alaaeldin F Moawad, MDNPI 1396835047
Title
Medical Director
Phone
(631) 504-5755

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 232607 NY Primary

Addresses

Primary practice location

116 Broadway
Amityville, NY 11701-2797

Mailing address

116 Broadway
Amityville, NY 11701-2797
Phone (631) 504-5755

Other names 1

  • long island medical of amityville pc Former legal business name

National Provider Directory

National Provider Directory

Locations

116 Broadway
Amityville, NY 11701
Phone (516) 908-9768

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1013420306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 BROADWAY",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012797",
            "telephone_number": "631-504-5755",
            "fax_number": "631-504-5756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 BROADWAY",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012797",
            "telephone_number": "631-504-5755",
            "fax_number": "631-504-5756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND MEDICAL OF AMITYVILLE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-09",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "MOAWAD",
        "authorized_official_first_name": "ALAAELDIN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "631-504-5755",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "232607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "long island medical of amityville pc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Amityville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.