Provider Demographics
NPI:1255439113
Name:SOUTH SHORE GYNECOLOGY OBSTETRICS ASSOCIATES PC
Entity type:Organization
Organization Name:SOUTH SHORE GYNECOLOGY OBSTETRICS ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HIRT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-277-5800
Mailing Address - Street 1:83 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2319
Mailing Address - Country:US
Mailing Address - Phone:631-277-5800
Mailing Address - Fax:631-277-1936
Practice Address - Street 1:83 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2319
Practice Address - Country:US
Practice Address - Phone:631-277-5800
Practice Address - Fax:631-277-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE51327Medicare UPIN
NYB20164Medicare UPIN
NYW07961Medicare UPIN
NYB78430Medicare UPIN