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General NPI Number Information
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NPI Number | 1154332344
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Entity Type | Organization
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Legal Business Name | SOUTH NASSAU ORTHOPEDIC SURGERY AND SPORTS MEDICINE, P.C.
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 64 S CENTRAL AVE
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City | VALLEY STREAM
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State | NY
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Zip | 11580-5407
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Country | US
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Telephone | 516-825-1101
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Fax | 516-568-2840
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Provider Business Mailing Address
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Address Line | 64 S CENTRAL AVE
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City | VALLEY STREAM
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State | NY
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Zip | 11580-5407
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Country | US
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Telephone | 516-825-1101
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Fax | 516-568-2840
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Authorized Official
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Title or Position | OPERATION MANAGER
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Name | NEESHA N MOHAMMED-LOPEZ
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Credential | M
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Telephone | 516-825-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 131901
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License Number State | NY
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