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General NPI Number Information
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NPI Number | 1356439145
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Entity Type | Organization
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Legal Business Name | SOUTH NASSAU PEDIATRICS,LLP
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 55 N OCEAN AVE
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City | FREEPORT
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State | NY
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Zip | 11520-3035
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Country | US
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Telephone | 516-379-1535
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Fax | 516-223-4962
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Provider Business Mailing Address
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Address Line | 55 N OCEAN AVE
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City | FREEPORT
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State | NY
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Zip | 11520-3035
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Country | US
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Telephone | 516-379-1535
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Fax | 516-223-4962
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. ANDREW LEWIS AGELOFF
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Credential | M.D.
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Telephone | 516-379-1535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 087868
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License Number State | NY
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