=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225399884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH SHORE PROCEDURES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2012
-----------------------------------------------------
Last Update Date | 05/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 N COUNTRY RD SUITE 201
-----------------------------------------------------
City | PORT JEFFERSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11777-2161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-331-0200
-----------------------------------------------------
Fax | 631-331-0202
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 N COUNTRY RD SUITE 201
-----------------------------------------------------
City | PORT JEFFERSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11777-2161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-331-0200
-----------------------------------------------------
Fax | 631-331-0202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALI S KARAKURUM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 631-331-0200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0800X
-----------------------------------------------------
Taxonomy Name | Endoscopy Clinic/Center
-----------------------------------------------------
License Number | 185973
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------