Provider Demographics
NPI:1750451001
Name:SOUTH SHORE PULMONARY MEDICINE PC
Entity Type:Organization
Organization Name:SOUTH SHORE PULMONARY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-569-6966
Mailing Address - Street 1:360 CENTRAL AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559
Mailing Address - Country:US
Mailing Address - Phone:516-569-6966
Mailing Address - Fax:516-569-4026
Practice Address - Street 1:360 CENTRAL AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559
Practice Address - Country:US
Practice Address - Phone:516-569-6966
Practice Address - Fax:516-569-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00940721Medicaid
W11141Medicare ID - Type UnspecifiedGROUP #