Provider Demographics
NPI:1225171408
Name:OCEANSIDE PEDIATRICS PC
Entity Type:Organization
Organization Name:OCEANSIDE PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HERSHEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-536-2000
Mailing Address - Street 1:3051 LONG BEACH RD
Mailing Address - Street 2:SUITE#1
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3240
Mailing Address - Country:US
Mailing Address - Phone:516-536-2000
Mailing Address - Fax:516-764-0257
Practice Address - Street 1:3051 LONG BEACH RD
Practice Address - Street 2:SUITE#1
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3240
Practice Address - Country:US
Practice Address - Phone:516-536-2000
Practice Address - Fax:516-764-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1090172080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01836671Medicaid
NY00384785Medicaid
NY01836671Medicaid