Long Island Medical of Amityville PC

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

Organization subpart

No

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

Authorized official

Name

Dr. Alaaeldin F Moawad, MD

Title

Medical Director

Phone

(631) 504-5755

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• long island medical of amityville pc Former legal business name

Locations

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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02647309",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "long island medical of amityville pc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Pediatrics Physician in Amityville, NY
• Providers in Amityville, NY by specialty
• Pediatrics Physician in New York

• 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.