Southside Hospital Faculty Practice

LBN: Southside Hospital Faculty Practice
Southside Hospital Faculty Practice is an health care organization with primary practice located at 301 E Main St , Bay Shore NY 11706-8408. The organization recently has 6 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Allopathic & Osteopathic Physicians / Internal Medicine is the primary health care specialty. Southside Hospital Faculty Practice can be contacted via phone (631) 675-4149, or through Mack, Winifred via phone (631) 968-9000.

Contact Information

Primary practice address
301 E Main St Bay Shore NY 11706-8408
Phone: (631) 675-4149
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Mack, Winifred
Phone: (631) 968-9000

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X
Allopathic & Osteopathic Physicians / Pediatrics 208000000X
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X

Profile Details

NPI number 1619934544
LBN Legal business name Southside Hospital Faculty Practice
DBA Doing business as
Authorized official Mack, Winifred
Entity Organization
Organization subpart 1 Yes
Enumeration date Apr 26th, 2006
Last updated Aug 13th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619934544 NPPES
New York MEDICAID 02167655

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