Provider Demographics
NPI:1053517557
Name:LONG ISLAND SPECIALIST PEDIATRICS PC
Entity type:Organization
Organization Name:LONG ISLAND SPECIALIST PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YIPING
Authorized Official - Middle Name:
Authorized Official - Last Name:GENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-353-7265
Mailing Address - Street 1:13304 41ST AVE # 1A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3629
Mailing Address - Country:US
Mailing Address - Phone:718-353-7265
Mailing Address - Fax:718-353-7267
Practice Address - Street 1:13304 41ST AVE # 1A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3629
Practice Address - Country:US
Practice Address - Phone:718-353-7265
Practice Address - Fax:718-353-7267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02600186Medicaid