1053688572 NPI number — NORTH SHORE-LIJ MEDICAL PC

Table of content: (NPI 1053688572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053688572 NPI number — NORTH SHORE-LIJ MEDICAL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE-LIJ MEDICAL PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053688572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
972 BRUSH HOLLOW RD FINANCE 5TH FLOOR
Provider Second Line Business Mailing Address:
ATTENTION WILLIAM J FUCHS
Provider Business Mailing Address City Name:
WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11590-1740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-876-6065
Provider Business Mailing Address Fax Number:
516-876-6600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 NORTHERN BLVD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREAT NECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11021-5306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-321-7400
Provider Business Practice Location Address Fax Number:
516-321-7498
Provider Enumeration Date:
11/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BRONSTORPH
Authorized Official First Name:
SHARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
516-850-3999

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 016982500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com