Provider Demographics
NPI:1497023964
Name:NORTH SHORE TMS LLC
Entity Type:Organization
Organization Name:NORTH SHORE TMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-923-0006
Mailing Address - Street 1:75 PROSPECT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3310
Mailing Address - Country:US
Mailing Address - Phone:631-923-0006
Mailing Address - Fax:631-498-0189
Practice Address - Street 1:75 PROSPECT ST STE 102
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3320
Practice Address - Country:US
Practice Address - Phone:631-923-0006
Practice Address - Fax:631-498-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242634261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty