Provider Demographics
NPI:1467582742
Name:ORTHOPAEDIC ASSOCIATES OF GREAT NECK,LLP
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF GREAT NECK,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:SIMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-773-7500
Mailing Address - Street 1:825 NORTHERN BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5323
Mailing Address - Country:US
Mailing Address - Phone:516-773-7500
Mailing Address - Fax:516-773-7575
Practice Address - Street 1:825 NORTHERN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5323
Practice Address - Country:US
Practice Address - Phone:516-773-7500
Practice Address - Fax:516-773-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA62189Medicare UPIN
NYB16716Medicare UPIN
NYI65749Medicare UPIN
NYE44221Medicare UPIN
NYE76286Medicare UPIN
NYW30511Medicare ID - Type Unspecified
1289980001Medicare NSC