Healthcare Provider Details

I. General information

NPI: 1417239500
Provider Name (Legal Business Name): NORTH SHORE HAMPTON MEDICAL AND SURGICAL EYE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 COMMERCE AVE SUITE 6 RIVERHEAD COMMERCE PARK
RIVERHEAD NY
11901-4454
US

IV. Provider business mailing address

260 MIDDLE COUNTRY RD 201
SMITHTOWN NY
11787-2982
US

V. Phone/Fax

Practice location:
  • Phone: 631-265-8780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: SHAUN ANDERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 631-265-8780