1164579942 NPI number — NASSAU EMERGENCY MEDICINE, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164579942 NPI number — NASSAU EMERGENCY MEDICINE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NASSAU EMERGENCY MEDICINE, P.C.
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:
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:
1164579942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1470
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT WASHINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11050-7470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-629-2454
Provider Business Mailing Address Fax Number:
516-629-2027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 PORT WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
DEPT. OF EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
ROSLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11576-1353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-629-2454
Provider Business Practice Location Address Fax Number:
516-629-2027
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOORNSTRA
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
516-562-6605

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com