Healthcare Provider Details

I. General information

NPI: 1114974094
Provider Name (Legal Business Name): NORTH SHORE INFECTIOUS DISEASES CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NORTHERN BLVD STE 205
GREENVALE NY
11548-1220
US

IV. Provider business mailing address

2200 NORTHERN BLVD STE 205
GREENVALE NY
11548-1220
US

V. Phone/Fax

Practice location:
  • Phone: 516-767-7771
  • Fax: 516-767-7765
Mailing address:
  • Phone: 516-767-7771
  • Fax: 516-767-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGIE RODRIGUEZ
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 516-767-7771