Healthcare Provider Details

I. General information

NPI: 1962697490
Provider Name (Legal Business Name): VETERANS ADMINISTRATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MIDDLEVILLE RD
NORTHPORT NY
11768-2200
US

IV. Provider business mailing address

15 JEAN PL
SYOSSET NY
11791-5914
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-4363
  • Fax:
Mailing address:
  • Phone: 516-558-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number245201
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number245201
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number245201
License Number StateNY

VIII. Authorized Official

Name: DR. XIYUN SHAO
Title or Position: ATTENDING PHYSICIAN
Credential: M.D.
Phone: 917-940-8711