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General NPI Number Information
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NPI Number | 1821294711
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Entity Type | Organization
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Legal Business Name | NORTH COAST MEDICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 415 PORT WASHINGTON BLVD
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-4201
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Country | US
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Telephone | 516-883-0218
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Fax | 516-767-0894
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Provider Business Mailing Address
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Address Line | 415 PORT WASHINGTON BLVD
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-4201
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Country | US
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Telephone | 516-883-0218
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Fax | 516-767-0894
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANNA LIZZA SIASOCO
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Credential | MD
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Telephone | 516-883-0218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 236459
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License Number State | NY
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