Provider Demographics
NPI:1952354235
Name:NORTH SHORE UROLOGY, LLP
Entity Type:Organization
Organization Name:NORTH SHORE UROLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HARLOWE
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-474-3000
Mailing Address - Street 1:5400 NESCONSET HWY
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2028
Mailing Address - Country:US
Mailing Address - Phone:631-474-3000
Mailing Address - Fax:631-474-2476
Practice Address - Street 1:5400 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2028
Practice Address - Country:US
Practice Address - Phone:631-474-3000
Practice Address - Fax:631-474-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152168208800000X
NY179311208800000X
NY1934791208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE54653Medicare UPIN
NYF49042Medicare UPIN
NYW86871Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER N
NYG38661Medicare UPIN