Healthcare Provider Details

I. General information

NPI: 1649382532
Provider Name (Legal Business Name): NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 E MAIN ST
HUNTINGTON NY
11743-2924
US

IV. Provider business mailing address

241 E MAIN ST
HUNTINGTON NY
11743-2924
US

V. Phone/Fax

Practice location:
  • Phone: 631-351-3700
  • Fax: 631-351-8247
Mailing address:
  • Phone: 631-351-3700
  • Fax: 631-351-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET STREET
Title or Position: ADMINISTRATOR
Credential:
Phone: 631-351-3703