=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699106187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NSLIJ
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2013
-----------------------------------------------------
Last Update Date | 12/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1999 MARCUS AVE STE 106C
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11042-1028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-233-3610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1999 MARCUS AVE
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11042-1033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-233-3610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SURGEON
-----------------------------------------------------
Name | DR. JOHN PLATZ
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 516-233-3610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 225014
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------