1528028917 NPI number — NORTH SHORE MEDICAL SPECIALTIES GROUP PC

Table of content: (NPI 1528028917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528028917 NPI number — NORTH SHORE MEDICAL SPECIALTIES GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE MEDICAL SPECIALTIES GROUP 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:
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:
1528028917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE HOLLOW LANE
Provider Second Line Business Mailing Address:
SUITE 312 NORTH SHORE MEDICAL SPECIALTIES GROUP PC
Provider Business Mailing Address City Name:
LAKE SUCCESS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-487-1414
Provider Business Mailing Address Fax Number:
516-487-0576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE HOLLOW LANE
Provider Second Line Business Practice Location Address:
SUITE 312 NORTH SHORE MEDICAL SPECIALTIES GROUP PC
Provider Business Practice Location Address City Name:
LAKE SUCCESS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-487-1414
Provider Business Practice Location Address Fax Number:
516-487-0576
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
BARTON
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PHYSICIAN PRESIDENT
Authorized Official Telephone Number:
516-487-1414

Provider Taxonomy Codes

  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CA9724 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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