Provider Demographics
NPI:1760931349
Name:SF NASSAU ASC LLC
Entity Type:Organization
Organization Name:SF NASSAU ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP RISK MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BERNICKY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-775-1564
Mailing Address - Street 1:2200 NORTHERN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1232
Mailing Address - Country:US
Mailing Address - Phone:516-234-8521
Mailing Address - Fax:
Practice Address - Street 1:2200 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1219
Practice Address - Country:US
Practice Address - Phone:516-243-8521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-24
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical