Provider Demographics
NPI:1902821820
Name:NASSAU HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:NASSAU HEALTHCARE CORPORATION
Other - Org Name:FREEPORT-ROOSEVELT HLTH CT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-572-6711
Mailing Address - Street 1:460 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1253
Mailing Address - Country:US
Mailing Address - Phone:516-572-8600
Mailing Address - Fax:
Practice Address - Street 1:460 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1253
Practice Address - Country:US
Practice Address - Phone:516-572-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2908201R261QA0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW33581Medicare ID - Type Unspecified