Provider Demographics
NPI:1053352658
Name:IMMANUEL, DAVID (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:IMMANUEL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2982
Mailing Address - Country:US
Mailing Address - Phone:631-265-8780
Mailing Address - Fax:631-257-5098
Practice Address - Street 1:230 HILTON AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8115
Practice Address - Country:US
Practice Address - Phone:631-265-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231402207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY575B61OtherEMPIRE BC- HEMPSTEAD
NY6C0380OtherHEALTHNET
NY575B62OtherEMPIRE BC-HICKSVILLE
NY175761POtherHIP
NY7602597OtherAETNA
NY000000083895OtherGHI HMO
NY02552734Medicaid
NY205299491OtherUNITED HEALTH CARE
NY231402-9WOtherWORKER'S COMP
NYP3321000OtherOXFORD
NY0147263OtherGHI PPO
NY1131132OtherAETNA HMO
NY169104OtherVYTRA
NY205299491OtherEMPIRE PLAN
NY575B61OtherEMPIRE BC- HEMPSTEAD
NY575B62OtherEMPIRE BC-HICKSVILLE