Provider Demographics
NPI:1447545843
Name:SOUTH NASSAU CARDIOVASCULAR PRACTICE, PC
Entity type:Organization
Organization Name:SOUTH NASSAU CARDIOVASCULAR PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-632-3965
Mailing Address - Street 1:1 HEALTHY WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1551
Mailing Address - Country:US
Mailing Address - Phone:516-632-3965
Mailing Address - Fax:
Practice Address - Street 1:1200 W BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1913
Practice Address - Country:US
Practice Address - Phone:516-887-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH NASSAU COMMUNITIES HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180648207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty