Healthcare Provider Details

I. General information

NPI: 1548287410
Provider Name (Legal Business Name): NORTH SHORE PRIMARY CARE MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOLLOW LN STE 109
NEW HYDE PARK NY
11042-1215
US

IV. Provider business mailing address

1 HOLLOW LN STE 109
NEW HYDE PARK NY
11042-1215
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-4433
  • Fax: 516-627-0552
Mailing address:
  • Phone: 516-627-4433
  • Fax: 516-627-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15517801
License Number StateNY

VIII. Authorized Official

Name: DAVID EDELSON
Title or Position: PRESIDENT
Credential:
Phone: 516-627-4433