MEDICARE: OCEANSIDE PEDIATRICS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	109017	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225171408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEANSIDE PEDIATRICS PC

Provider Business Mailing Address
First Line	:	3051 LONG BEACH RD
Second Line	:	SUITE#1
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3240
Country	:	US
Telephone Number	:	516-536-2000
Fax Number	:	516-764-0257

Provider Business Practice Location Address
First Line	:	3051 LONG BEACH RD
Second Line	:	SUITE#1
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3240
Country	:	US
Telephone Number	:	516-536-2000
Fax Number	:	516-764-0257

Authorized Official
Title or Position	:	PEDIATRICIAN
Name	:	DR. HERSHEL H GLATT
Credential	:	M.D.
Telephone Number	:	516-536-2000

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	08/22/2020

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Directions to “OCEANSIDE PEDIATRICS PC ” Practice Location

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