Healthcare Provider Details

I. General information

NPI: 1255264131
Provider Name (Legal Business Name): GREAT NECK RHEUMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NORTHERN BLVD STE 260
GREAT NECK NY
11021-5341
US

IV. Provider business mailing address

1000 NORTHERN BLVD STE 260
GREAT NECK NY
11021-5341
US

V. Phone/Fax

Practice location:
  • Phone: 516-928-6512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHU CAO
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-928-6512