Lynbrook SC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

2907200R Issued in NY

Legal business name

LYNBROOK SC LLC

Doing business as

Lynbrook Surgery Center

Practice address

444 Merrick Rd
Ste 400
Lynbrook, NY 11563-2400

Phone

(516) 887-0890

Fax

(516) 887-6219

NPI assigned

Jun 8, 2005

Last updated

Sep 28, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jay I Raifman

Title

Administrator

Phone

(516) 887-0890

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lynbrook Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Listed as

South Shore Ambulatory Surgery CenterCCN 33C0001067

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Adam R Boll, PA

  • Orthopaedic Surgery Physician
  • Glen Cove, NY
  • NPI 1174643159
  NPD (past)
• Bennett Howard Brown, MD

  • Orthopaedic Hand Surgery Physician
  • Rockville Centre, NY
  • NPI 1457525321
  NPD (past)

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632787200000",
    "number": "1659375632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 MERRICK RD",
            "city": "LYNBROOK",
            "state": "NY",
            "postal_code": "11563",
            "telephone_number": "516-887-0890",
            "fax_number": "516-887-6219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 MERRICK RD",
            "address_2": "STE 400",
            "city": "LYNBROOK",
            "state": "NY",
            "postal_code": "115632400",
            "telephone_number": "516-887-0890",
            "fax_number": "516-887-6219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYNBROOK SC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "RAIFMAN",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "516-887-0890"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NY",
            "license": "2907200R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02518761",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lynbrook Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Luxury Dental of Lynbrook PLLC
• Lynbrook Drugs Corp
• Lynbrook Luxury Dental,PC
• Lynbrook Medical Diagnostic Ultrasound
• Lynbrook Podiatry PLLC
• Lynbrook Union Free School District
• Ludy Anne Maca
• Ricky Juan Biscocho Maca, PTA
• Kathleen Magner, DPT
• Efraim Malayev, PHARMD

• Ambulatory Surgical Clinic/Center in Lynbrook, NY
• Providers in Lynbrook, NY by specialty
• Ambulatory Surgical Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.