Provider Demographics
NPI:1457910374
Name:NASSAU COUNTY SH MEDICAL PC
Entity Type:Organization
Organization Name:NASSAU COUNTY SH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-878-4314
Mailing Address - Street 1:1396 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4513
Mailing Address - Country:US
Mailing Address - Phone:718-878-4314
Mailing Address - Fax:866-611-7203
Practice Address - Street 1:1396 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4513
Practice Address - Country:US
Practice Address - Phone:718-878-4314
Practice Address - Fax:866-611-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty