Provider Demographics
NPI:1598830531
Name:NORTH NASSAU MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTH NASSAU MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KURZWEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-671-7770
Mailing Address - Street 1:235 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2034
Mailing Address - Country:US
Mailing Address - Phone:516-671-7770
Mailing Address - Fax:516-671-6372
Practice Address - Street 1:235 FOREST AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2034
Practice Address - Country:US
Practice Address - Phone:516-671-7770
Practice Address - Fax:516-671-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02810617Medicaid
WEU2010Medicare ID - Type Unspecified