Healthcare Provider Details

I. General information

NPI: 1225171408
Provider Name (Legal Business Name): OCEANSIDE PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 LONG BEACH RD SUITE#1
OCEANSIDE NY
11572-3240
US

IV. Provider business mailing address

3051 LONG BEACH RD SUITE#1
OCEANSIDE NY
11572-3240
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-2000
  • Fax: 516-764-0257
Mailing address:
  • Phone: 516-536-2000
  • Fax: 516-764-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number109017
License Number StateNY

VIII. Authorized Official

Name: DR. HERSHEL H GLATT
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 516-536-2000