LONG ISLAND SKIN CANCER AND DERMATOLOGIC SURGERY, PC (NPI# 1689677197) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689677197 |
| Entity Type | Organization |
| Organization Name | LONG ISLAND SKIN CANCER AND DERMATOLOGIC SURGERY, PC |
| Practice Address |
994 W Jericho Tpke Ste 103 Smithtown NY 11787-3211 |
| Practice Telephone | 6318646647 |
| Practice Fax Number | 6318646001 |
| Mailing Telephone | 6318646647 |
| Mailing Fax Number | 6318646001 |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. ANTHONY L. WONG (SECRETARY/TREASURER) |
| Authorized Official Telephone | 3475244033 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 226570 | NY | Other Service Providers |
| Street Address |
994 W JERICHO TPKE STE 103 |
| City | SMITHTOWN |
| State | NY |
| Zip Code | 11787-3211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013402932 | Rachel Anne Demaio | Nurse Practitioner | 994 W Jericho Tpke, Smithtown, NY 11787-3235 | 2018-06-22 |
| 1366873259 | Delta Sleep Center | Sleep Specialist, PhD | 994 W Jericho Tpke, Smithtown, NY 11787-3235 | 2013-12-03 |
| 1184999344 | Melinda Clarke | Registered Nurse | 994 W Jericho Tpke, Smithtown, NY 11787-3235 | 2012-03-20 |
| 1134457518 | Allison Wallshein | Registered Nurse | 994 W Jericho Tpke, Suite 202, Smithtown, NY 11787-3235 | 2009-11-24 |
| 1538302179 | Gulle Nayab Awan | Pain Medicine | 994 W Jericho Tpke, Suite 104, Smithtown, NY 11787-3235 | 2009-04-13 |
| 1245407519 | Michele A Morganstern | Psychologist | 994 W Jericho Tpke, Suite 202, Smithtown, NY 11787-3235 | 2008-05-14 |
| 1235303157 | Lloyd D. Landsman, M.d.p.c. | Plastic Surgery | 994 W Jericho Tpke, Smithtown, NY 11787-3235 | 2008-04-22 |
| 1851595094 | Long Island Skin Cancer & Dermatologic Surgery, PC | Dermatology | 994 W Jericho Tpke, Suite 103, Smithtown, NY 11787-3235 | 2007-06-12 |
| 1508077058 | Jennifer Fidelo | Physician Assistant | 994 W Jericho Tpke, Suite 202, Smithtown, NY 11787-3235 | 2007-05-25 |
| 1013071323 | Karin Eva Burkhard | Psychiatry & Neurology | 994 W Jericho Tpke, Suite 202, Smithtown, NY 11787-3235 | 2006-12-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558962779 | Gwendolyn Burris | Counselor | 20 Gilbert Avenue, Suite 107-a, Smithtown, NY 11787 | 2020-11-04 |
| 1467051193 | Karin M Caro | Adult Companion | 9 Three Pond Road, Smithtown, NY 11787 | 2020-10-23 |
| 1639706641 | Nimit Khara | Student in an Organized Health Care Education/Training Program | 240 Middle Country Rd A, Smithtown, NY 11787 | 2020-03-27 |
| 1003469032 | Maria Teresa Gardella | Nurse Practitioner | St. Catherine of Siena Medical Center, 50 Ny-25a, Smithtown, NY 11787 | 2019-07-18 |
| 1558922070 | Pamella Ann Grillo | Physician Assistant | 373 Ny-111 #5, Smithtown, NY 11787 | 2019-06-25 |
| 1306308127 | Sherry Hansen | Social Worker | 285 Middle Country Rd, Suite Ll5, Smithtown, NY 11787 | 2019-04-01 |
| 1932663747 | Kayla Roundsman | Counselor | 11 Route 11, Smithtown, NY 11787 | 2019-01-25 |
| 1568959856 | Moreen Johnson | Registered Nurse | Christian Nursing Registry, 17 Bank Ave, Smith Town, NY 11787 | 2018-04-23 |
| 1992217871 | Erica Zeller Licensed Clinical Social Work Pllc | Social Worker | 15 Bellemeade Ave Ste 3, Smithtown, NY 11787 | 2017-10-31 |
| 1881117802 | Oisin Vincent Keenan | Case Manager/Care Coordinator | 11 Ny-111, Smithtown, NY 11787 | 2017-07-21 |
| Find all providers in zip 11787 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497368039 | Donna T Jensen | Specialist | 23 Marquette Dr, Smithtown, NY 11787-2022 | 2020-08-24 |
| 1184266256 | Jenny Marie Portuallo | Specialist | 1 Oakside Rd, Smithtown, NY 11787-1555 | 2019-10-10 |
| 1295384089 | Brittany L Helfner | Specialist | 390 N Country Rd, Smithtown, NY 11787-2066 | 2019-09-05 |
| 1447711056 | Lyndsay Mccormack | Specialist | 36 Asbury Dr, Smithtown, NY 11787-3127 | 2019-03-27 |
| 1609347335 | Theater Surgical Arts Office Based Surgery, PC | Specialist | 994 W Jericho Tpke Ste 102, Smithtown, NY 11787-3211 | 2018-12-06 |
| 1386153096 | Kathleen Ann Farrell | Specialist | 213 Holly Ln, Smithtown, NY 11787-4430 | 2017-09-26 |
| 1275055790 | Angela Sue Gallagher | Specialist | 29 Hemlock Lane, Smithtown, NY 11787 | 2017-07-17 |
| 1134658271 | Katherine Flaherty | Specialist | 44 Route 25a Apt 512, Smithtown, NY 11787-1413 | 2017-06-11 |
| 1164963872 | Lauren Cillis | Specialist | 4 Darling Ave, Smithtown, NY 11787-4605 | 2017-03-14 |
| 1457896383 | Salvatore Finocchiaro | Specialist | 48 Birchbrook Dr, Smithtown, NY 11787-3602 | 2017-01-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.