Healthcare Provider Details

I. General information

NPI: 1285745299
Provider Name (Legal Business Name): SEA SHORE RADIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BEACH 19TH ST RADIOLOGY DEPT.
FAR ROCKAWAY NY
11691-4423
US

IV. Provider business mailing address

1575 HILLSIDE AVE SUITE 301
NEW HYDE PARK NY
11040-2501
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-7710
  • Fax: 718-869-7192
Mailing address:
  • Phone: 516-354-4200
  • Fax: 516-358-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS R ROSSI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-354-4200