Provider Demographics
NPI:1255840807
Name:THE MEDICAL STATION OF NORTH SHORE PC
Entity Type:Organization
Organization Name:THE MEDICAL STATION OF NORTH SHORE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-759-5406
Mailing Address - Street 1:480 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-2151
Mailing Address - Country:US
Mailing Address - Phone:516-759-5406
Mailing Address - Fax:516-759-5537
Practice Address - Street 1:480 FOREST AVE
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560
Practice Address - Country:US
Practice Address - Phone:516-759-5406
Practice Address - Fax:516-759-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5395P1OtherEMPIRE BLUE CROSS BLUE SHIELD