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General NPI Number Information
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NPI Number | 1053688572
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Entity Type | Organization
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Legal Business Name | NORTH SHORE-LIJ MEDICAL PC
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 1010 NORTHERN BLVD STE 110
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City | GREAT NECK
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State | NY
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Zip | 11021-5306
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Country | US
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Telephone | 516-321-7400
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Fax | 516-321-7498
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Provider Business Mailing Address
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Address Line | 972 BRUSH HOLLOW RD FINANCE 5TH FLOOR ATTENTION WILLIAM J FUCHS
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City | WESTBURY
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State | NY
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Zip | 11590-1740
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Country | US
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Telephone | 516-876-6065
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Fax | 516-876-6600
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHARLENE BRONSTORPH
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Credential |
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Telephone | 516-850-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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