Healthcare Provider Details

I. General information

NPI: 1578981148
Provider Name (Legal Business Name): SOUTH SHORE WOMENS MEDICAL ASSOICATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 MERRICK RD
ROCKVILLE CENTRE NY
11570-5487
US

IV. Provider business mailing address

556 MERRICK RD
ROCKVILLE CENTRE NY
11570-5487
US

V. Phone/Fax

Practice location:
  • Phone: 516-255-2044
  • Fax:
Mailing address:
  • Phone: 516-255-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number1530671
License Number StateNY

VIII. Authorized Official

Name: DR. JOAN S. HASELKORN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 516-255-2044