1598933822 NPI number — SOUTH SHORE NUCLEAR DIAGNOSTICS, PC

Table of content: (NPI 1598933822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598933822 NPI number — SOUTH SHORE NUCLEAR DIAGNOSTICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH SHORE NUCLEAR DIAGNOSTICS, 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:
1598933822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12186
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAUPPAUGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11788-0856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-952-5701
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 MERRICK RD
Provider Second Line Business Practice Location Address:
SUITE LL5
Provider Business Practice Location Address City Name:
LYNBROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11563-2460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-561-8558
Provider Business Practice Location Address Fax Number:
516-561-6706
Provider Enumeration Date:
02/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WEINSTEIN
Authorized Official First Name:
GILBERT
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-967-9200

Provider Taxonomy Codes

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

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





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