Mid Island Internal Medicine, PLLC

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

199922 Issued in NY

Legal business name

MID ISLAND INTERNAL MEDICINE, PLLC

Practice address

709 Hawkins Ave
Ronkonkoma, NY 11779-4243

Phone

(631) 588-0880

Fax

(631) 588-0391

NPI assigned

Sep 19, 2007

Organization subpart

No

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

Authorized official

Name

Jennifer E Liotta

Title

Office Manager

Phone

(631) 588-0880

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243382400000",
    "number": "1750577201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 HAWKINS AVE",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117792293",
            "telephone_number": "631-588-0880",
            "fax_number": "631-588-0391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HAWKINS AVE",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117794243",
            "telephone_number": "631-588-0880",
            "fax_number": "631-588-0391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID ISLAND INTERNAL MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-19",
        "last_updated": "2009-05-27",
        "status": "A",
        "authorized_official_last_name": "LIOTTA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "631-588-0880"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "199922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Legal Medicine in Ronkonkoma, NY
• Providers in Ronkonkoma, NY by specialty
• Legal Medicine in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; 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.