Provider Demographics
NPI:1053472050
Name:SOUTH SHORE PULMONARY,CRITICAL CARE & SLEEP MEDICINE,PLLC
Entity Type:Organization
Organization Name:SOUTH SHORE PULMONARY,CRITICAL CARE & SLEEP MEDICINE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAJESHRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-432-1818
Mailing Address - Street 1:430 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2351
Mailing Address - Country:US
Mailing Address - Phone:516-432-1818
Mailing Address - Fax:516-432-9333
Practice Address - Street 1:430 E BAY DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2351
Practice Address - Country:US
Practice Address - Phone:516-432-1818
Practice Address - Fax:516-432-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233667207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWET761Medicare ID - Type UnspecifiedPROVIDER ID