Healthcare Provider Details

I. General information

NPI: 1639256662
Provider Name (Legal Business Name): NORTH SHORE MEDICAL ARTS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 COMMUNITY DR
GREAT NECK NY
11021-5505
US

IV. Provider business mailing address

295 COMMUNITY DR
GREAT NECK NY
11021-5505
US

V. Phone/Fax

Practice location:
  • Phone: 516-504-0800
  • Fax: 516-504-0824
Mailing address:
  • Phone: 516-504-0800
  • Fax: 516-504-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. SANFORD M RATNER
Title or Position: PHYSICIAN
Credential: MD
Phone: 516-504-0800