Provider Demographics
NPI:1891766523
Name:SOUTH SHORE GASTROENTEROLOGY PC
Entity Type:Organization
Organization Name:SOUTH SHORE GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KADISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-374-0670
Mailing Address - Street 1:657 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516
Mailing Address - Country:US
Mailing Address - Phone:516-374-0670
Mailing Address - Fax:516-295-0648
Practice Address - Street 1:657 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516
Practice Address - Country:US
Practice Address - Phone:516-374-0670
Practice Address - Fax:516-295-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW85251Medicare PIN