Provider Demographics
NPI:1841213923
Name:NORTH SHORE SURGI-CENTER INC
Entity Type:Organization
Organization Name:NORTH SHORE SURGI-CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-864-6891
Mailing Address - Street 1:989 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3203
Mailing Address - Country:US
Mailing Address - Phone:631-864-7100
Mailing Address - Fax:631-864-7129
Practice Address - Street 1:989 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3203
Practice Address - Country:US
Practice Address - Phone:631-864-7100
Practice Address - Fax:631-864-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5157204R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01178321Medicaid
NY1CZ95111Medicare PIN
NYZ95111Medicare ID - Type Unspecified