1205062502 NPI number — NORTH SHORE UNIVERSITY HOSPITAL

Table of content: DR. REBECCA WAMBAUGH SHORT M.D. (NPI 1407947872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205062502 NPI number — NORTH SHORE UNIVERSITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE UNIVERSITY HOSPITAL
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:
1205062502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 COMMUNITY DR
Provider Second Line Business Mailing Address:
VIVO HEALTH PHARMACY AT MANHASSET
Provider Business Mailing Address City Name:
MANHASSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11030-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-322-5121
Provider Business Mailing Address Fax Number:
516-941-0747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 COMMUNITY DR
Provider Second Line Business Practice Location Address:
VIVO HEALTH PHARMACY AT MANHASSET
Provider Business Practice Location Address City Name:
MANHASSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11030-3816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-322-5121
Provider Business Practice Location Address Fax Number:
516-941-0747
Provider Enumeration Date:
06/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NEUMANN
Authorized Official First Name:
NEAL
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
DIRECTOR OF PHARMACY OPERATIONS
Authorized Official Telephone Number:
516-322-5121

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  029422 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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