Healthcare Provider Details

I. General information

NPI: 1528028917
Provider Name (Legal Business Name): NORTH SHORE MEDICAL SPECIALTIES GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOLLOW LANE SUITE 312 NORTH SHORE MEDICAL SPECIALTIES GROUP PC
LAKE SUCCESS NY
11042
US

IV. Provider business mailing address

ONE HOLLOW LANE SUITE 312 NORTH SHORE MEDICAL SPECIALTIES GROUP PC
LAKE SUCCESS NY
11042
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-1414
  • Fax: 516-487-0576
Mailing address:
  • Phone: 516-487-1414
  • Fax: 516-487-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BARTON E COHEN
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 516-487-1414