Today, Middle Island is built up with homes, churches, co-op apartment complexes, condominiums, car dealerships, discount stores, and small businesses.

It is situated between the towns of Coram and Ridge, to the west and east, respectively, and Rocky Point and Yaphank to the north and south. The name derives from the fact that it lies approximately half way between the Eastern and Western ends of Long Island (East River and Montauk Point) as well as half way between the Northern and Southern boundaries (Long Island Sound and the Atlantic Ocean).

Parks within Middle Island include Cathedral Pines County Park (formerly a Boy Scout Camp) and the adjacent Prosser Pines County Park. Middle Island is surrounded by three public golf courses. Middle Island Country Club and Spring Lake Golf Club are both within Middle Island; Mill Pond Golf Course is just to the South, in Yaphank.