Provider Demographics
NPI:1710033931
Name:NORTH NASSAU ENDOCRINOLOGY AND DIABETES PLLC
Entity Type:Organization
Organization Name:NORTH NASSAU ENDOCRINOLOGY AND DIABETES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-829-0802
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-829-0802
Mailing Address - Fax:516-487-9433
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-829-0802
Practice Address - Fax:516-487-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203765207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01875938Medicaid
NY01875938Medicaid
NY36N451Medicare ID - Type Unspecified