Healthcare Provider Details

I. General information

NPI: 1154332344
Provider Name (Legal Business Name): SOUTH NASSAU ORTHOPEDIC SURGERY AND SPORTS MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E MERRICK RD
VALLEY STREAM NY
11580-5947
US

IV. Provider business mailing address

185 KINGSLAND ST
NUTLEY NJ
07110-1119
US

V. Phone/Fax

Practice location:
  • Phone: 516-825-1101
  • Fax: 718-766-9763
Mailing address:
  • Phone: 516-825-1101
  • Fax: 718-766-9763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BETSY VARGAS
Title or Position: BILLING COLLECTIONS MANAGER
Credential:
Phone: 973-816-2259