Provider Demographics
NPI:1164042156
Name:NORTH SHORE COMPLETE MEDICAL PC
Entity Type:Organization
Organization Name:NORTH SHORE COMPLETE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-403-9104
Mailing Address - Street 1:40 RED BROOK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1439
Mailing Address - Country:US
Mailing Address - Phone:516-403-9104
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3816
Practice Address - Country:US
Practice Address - Phone:516-403-9104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty