1245586528 NPI number — NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE

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 1245586528 NPI number — NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE
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:
1245586528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 ROUTE 25A
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
SMITHTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11787-1431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-382-4833
Provider Business Mailing Address Fax Number:
631-382-4836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 ROUTE 25A
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
SMITHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11787-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-382-4833
Provider Business Practice Location Address Fax Number:
631-382-4836
Provider Enumeration Date:
07/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
STREET
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
631-351-3703

Provider Taxonomy Codes

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

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





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