Provider Demographics
NPI:1053337220
Name:NORTH SHORE SURGI-CENTER INC.
Entity type:Organization
Organization Name:NORTH SHORE SURGI-CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-864-6891
Mailing Address - Street 1:989 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3203
Mailing Address - Country:US
Mailing Address - Phone:631-864-6891
Mailing Address - Fax:631-864-6895
Practice Address - Street 1:989 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3203
Practice Address - Country:US
Practice Address - Phone:631-864-6891
Practice Address - Fax:631-864-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS0W287510Medicare PIN
NYW28751Medicare ID - Type UnspecifiedANESTHESIA GROUP