Healthcare Provider Details

I. General information

NPI: 1285330290
Provider Name (Legal Business Name): NORTH SHORE AMSURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BROADHOLLOW RD STE 100
MELVILLE NY
11747-3606
US

IV. Provider business mailing address

510 BROADHOLLOW RD STE 100
MELVILLE NY
11747-3606
US

V. Phone/Fax

Practice location:
  • Phone: 631-424-3600
  • Fax:
Mailing address:
  • Phone: 631-470-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE PYNE
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-424-3600