Healthcare Provider Details

I. General information

NPI: 1841213923
Provider Name (Legal Business Name): NORTH SHORE SURGI-CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 W JERICHO TPKE
SMITHTOWN NY
11787-3203
US

IV. Provider business mailing address

989 W JERICHO TPKE
SMITHTOWN NY
11787-3203
US

V. Phone/Fax

Practice location:
  • Phone: 631-864-7100
  • Fax: 631-864-7129
Mailing address:
  • Phone: 631-864-7100
  • Fax: 631-864-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number5157204R
License Number StateNY

VIII. Authorized Official

Name: MRS. PAULA ANNE BRUNO
Title or Position: BILLING MANAGER
Credential:
Phone: 631-864-6891