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General NPI Number Information
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NPI Number | 1942243654
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Entity Type | Organization
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Legal Business Name | NORTH SHORE CARDIOLOGY & INTERNAL MEDICINE ASSOCIATES PC
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 1010 NORTHERN BOULEVARD
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City | GREAT NECK
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State | NY
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Zip | 11021
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Country | US
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Telephone | 516-390-2400
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Fax | 516-482-7955
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Provider Business Mailing Address
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Address Line | 1010 NORTHERN BOULEVARD
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City | GREAT NECK
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State | NY
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Zip | 11021
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Country | US
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Telephone | 516-390-2400
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Fax | 516-482-7955
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | LESLIE COOPERMAN
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Credential | MD
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Telephone | 516-390-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 107129
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License Number State | NY
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