Provider Demographics
NPI:1528028917
Name:NORTH SHORE MEDICAL SPECIALTIES GROUP PC
Entity Type:Organization
Organization Name:NORTH SHORE MEDICAL SPECIALTIES GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-487-1414
Mailing Address - Street 1:ONE HOLLOW LANE
Mailing Address - Street 2:SUITE 312 NORTH SHORE MEDICAL SPECIALTIES GROUP PC
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-487-1414
Mailing Address - Fax:516-487-0576
Practice Address - Street 1:ONE HOLLOW LANE
Practice Address - Street 2:SUITE 312 NORTH SHORE MEDICAL SPECIALTIES GROUP PC
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-487-1414
Practice Address - Fax:516-487-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCA9724OtherMEDICARE RAILROAD
NYW22431Medicare PIN