1487006177 NPI number — THORACICSURGICAL SPECIALIST PC

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 1487006177 NPI number — THORACICSURGICAL SPECIALIST PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THORACICSURGICAL SPECIALIST 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:
1487006177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
891 NORTHERN BLVD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
GREAT NECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11021-5334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-586-8989
Provider Business Mailing Address Fax Number:
516-726-8295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
891 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
GREAT NECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11021-5334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-586-8989
Provider Business Practice Location Address Fax Number:
516-726-8295
Provider Enumeration Date:
07/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SPIER
Authorized Official First Name:
LAURENCE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-586-8989

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  189052 , 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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