MEDICARE: SOUTH NASSAU CARDIOVASCULAR PRACTICE, 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	207RC0000X	Cardiovascular Disease Physician	180648	NY

General Provider Information

NPI Number	:	1447545843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH NASSAU CARDIOVASCULAR PRACTICE, PC

Provider Business Mailing Address
First Line	:	1 HEALTHY WAY
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-1551
Country	:	US
Telephone Number	:	516-632-3965
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W BROADWAY
Second Line	:
City	:	HEWLETT
State	:	NY
Zip	:	11557-1913
Country	:	US
Telephone Number	:	516-887-7000
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCE
Name	:	MARK BOGEN
Credential	:
Telephone Number	:	516-632-3965

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	06/14/2011

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