Provider Demographics
NPI:1821294711
Name:NORTH COAST MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:NORTH COAST MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:LIZZA
Authorized Official - Last Name:SIASOCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-883-0218
Mailing Address - Street 1:415 PORT WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4201
Mailing Address - Country:US
Mailing Address - Phone:516-883-0218
Mailing Address - Fax:516-767-0894
Practice Address - Street 1:415 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4201
Practice Address - Country:US
Practice Address - Phone:516-883-0218
Practice Address - Fax:516-767-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3363P1OtherBLUE CROSS BLUE SHIELD
NY6C0603OtherHEALTH NET OF NORTHEAST
NYSA6459OtherATLANTIS
NYP3698445OtherOXFORD
NY5880458OtherCIGNA
NY5995775OtherGHI
NYAA73558AOtherMDNY
NM286811POtherHIP
NY9412517OtherPHCS
NY051903998OtherMAGNACARE
NY2554307OtherUHC
NY=========OtherMULTIPLAN
NY4830P10Medicare ID - Type UnspecifiedVINCENT
NY5995775OtherGHI
NYI67034Medicare UPIN
NY3363P1OtherBLUE CROSS BLUE SHIELD
NYAA73558AOtherMDNY
NY=========OtherMULTIPLAN