Provider Demographics
NPI:1518078799
Name:CHILDREN'S SURGICAL GROUP PC
Entity Type:Organization
Organization Name:CHILDREN'S SURGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:COREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-997-1199
Mailing Address - Street 1:320 POST AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-997-1199
Mailing Address - Fax:516-997-1229
Practice Address - Street 1:320 POST AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-997-1199
Practice Address - Fax:516-997-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty