Provider Demographics
NPI:1275671604
Name:SOUTH SHORE THORACIC & CARDIOVASCULAR SURGICAL GROUP PC
Entity Type:Organization
Organization Name:SOUTH SHORE THORACIC & CARDIOVASCULAR SURGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SLOVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-734-2300
Mailing Address - Street 1:5115 BEACH CHANNEL DRIVE
Mailing Address - Street 2:SUITE 418
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-734-2300
Mailing Address - Fax:718-734-2430
Practice Address - Street 1:5115 BEACH CHANNEL DR
Practice Address - Street 2:SUITE 418
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-734-2300
Practice Address - Fax:718-734-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03199Medicare ID - Type UnspecifiedGHI