Provider Demographics
NPI:1083775852
Name:BAY SHORE PHYSICAL MEDICINE &REHABILITATION
Entity Type:Organization
Organization Name:BAY SHORE PHYSICAL MEDICINE &REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-665-4448
Mailing Address - Street 1:41 SAXON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7021
Mailing Address - Country:US
Mailing Address - Phone:631-665-4448
Mailing Address - Fax:631-665-4449
Practice Address - Street 1:41 SAXON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7021
Practice Address - Country:US
Practice Address - Phone:631-665-4448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157502208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00889652Medicaid
NY00889652Medicaid
NYWEH411Medicare ID - Type UnspecifiedMEDICARE GROUP
NYA63071Medicare UPIN