Provider Demographics
NPI:1053623041
Name:ISLAND MEDICAL EMPIRE STATE, PLLC
Entity type:Organization
Organization Name:ISLAND MEDICAL EMPIRE STATE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-514-7600
Mailing Address - Street 1:350 MOTOR PKWY
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5101
Mailing Address - Country:US
Mailing Address - Phone:631-514-7600
Mailing Address - Fax:631-813-1472
Practice Address - Street 1:ONE NORTON AVENUE, EMERGENCY DEPARTMENT
Practice Address - Street 2:A. O. FOX MEMORIAL HOSPITAL
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2629
Practice Address - Country:US
Practice Address - Phone:607-431-5003
Practice Address - Fax:607-431-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty