Healthcare Provider Details

I. General information

NPI: 1881740926
Provider Name (Legal Business Name): NORTH SHORE SURGICAL ONCOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD SUITE 111
GREAT NECK NY
11021-5200
US

IV. Provider business mailing address

600 NORTHERN BLVD SUITE 111
GREAT NECK NY
11021-5200
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-8853
  • Fax:
Mailing address:
  • Phone: 516-487-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number173388
License Number StateNY

VIII. Authorized Official

Name: DR. CHARLES C CONTE
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 516-487-8853