Provider Demographics
NPI:1073594800
Name:SOUTH NASSAU COMMUNITIES HOSPITAL
Entity Type:Organization
Organization Name:SOUTH NASSAU COMMUNITIES HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-632-3000
Mailing Address - Street 1:ONE HEALTHY WAY
Mailing Address - Street 2:ATTN: PHYSICIAN BILLING
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572
Mailing Address - Country:US
Mailing Address - Phone:516-255-1616
Mailing Address - Fax:
Practice Address - Street 1:ONE HEALTHY WAY
Practice Address - Street 2:ATTN: PHYSICIAN BILLING
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572
Practice Address - Country:US
Practice Address - Phone:516-255-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW75731Medicare ID - Type Unspecified