Healthcare Provider Details

I. General information

NPI: 1295716835
Provider Name (Legal Business Name): SOUTH NASSAU COMMUNITIES HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY ATTN: PHYSICIAN BILLING
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

1 HEALTHY WAY ATTN: PHYSICIAN BILLING
OCEANSIDE NY
11572-1551
US

V. Phone/Fax

Practice location:
  • Phone: 516-255-1600
  • Fax: 516-255-4672
Mailing address:
  • Phone: 516-255-1600
  • Fax: 516-255-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003479
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number214473
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number112253
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number204027
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number201704
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number158539
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number242239
License Number StateNY
# 8
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number218259
License Number StateNY

VIII. Authorized Official

Name: ALEX BALKO
Title or Position: DIRECTOR-FINANCE
Credential:
Phone: 516-632-3681