NPIMap

Organization Active NPI

Long Island Surgical PLLC

  • Surgery Physician
  • Rockville Centre, NY
National Provider Identifier
1588039119
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
258825-1 Issued in NY
Legal business name
LONG ISLAND SURGICAL PLLC
Practice address
2000 N Village Ave Ste 211
Rockville Centre, NY 11570-1001
Phone
(516) 900-7922
Fax
(516) 268-6398
NPI assigned
Dec 8, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Authorized official

Name
Joshua Haller
Title
Manager
Phone
(516) 714-3766

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 258825-1 NY Primary

Addresses

Primary practice location

2000 N Village Ave Ste 211
Rockville Centre, NY 11570-1001

Mailing address

PO Box 621
Woodmere, NY 11598-0621
Phone (516) 714-3766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190812003350 NY Part B Supplier - Clinic/Group Practice 8628305786 Receives reassigned benefits from 15 practitioners
Practice locations: Bethpage, NY; Rockville Centre, NY

National Provider Directory

National Provider Directory

Locations

4271 Hempstead Tpke
Ste 211
Bethpage, NY 11714
Phone (516) 900-7922

220 Beach 20th St
Far Rockaway, NY 11691
Phone (718) 327-3200

2000 N Village Ave
Ste 211
Rockville Ctr, NY 11570
Phone (516) 764-1303

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1449532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1588039119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 621",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115980621",
            "telephone_number": "516-714-3766",
            "fax_number": "516-268-6398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N VILLAGE AVE STE 211",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115701001",
            "telephone_number": "516-900-7922",
            "fax_number": "516-268-6398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND SURGICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-08",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "HALLER",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "516-714-3766"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "NY",
            "license": "258825-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.