Provider Demographics
NPI:1598933822
Name:SOUTH SHORE NUCLEAR DIAGNOSTICS, PC
Entity Type:Organization
Organization Name:SOUTH SHORE NUCLEAR DIAGNOSTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-967-9200
Mailing Address - Street 1:PO BOX 12186
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0856
Mailing Address - Country:US
Mailing Address - Phone:631-952-5701
Mailing Address - Fax:
Practice Address - Street 1:444 MERRICK RD
Practice Address - Street 2:SUITE LL5
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2460
Practice Address - Country:US
Practice Address - Phone:516-561-8558
Practice Address - Fax:516-561-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEW731Medicare PIN