NPIMap

Organization Active NPI

North Shore Medical Group of Mt Sinai School of Medicine

Doing business as North Shore Medical Group

  • Internal Medicine Physician
  • Lake Ronkonkoma, NY
National Provider Identifier
1003121013
Registry record updated Aug 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
NORTH SHORE MEDICAL GROUP OF MT SINAI SCHOOL OF MEDICINE
Doing business as
North Shore Medical Group
Practice address
201 Portion Rd
Suite C
Lake Ronkonkoma, NY 11779-4172
Phone
(631) 585-5959
NPI assigned
Aug 13, 2010
Last updated
Aug 13, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janet Street
Title
Administrator
Phone
(631) 351-3703

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

201 Portion Rd
Suite C
Lake Ronkonkoma, NY 11779-4172

Mailing address

201 Portion Rd
Suite C
Lake Ronkonkoma, NY 11779-4172
Phone (631) 585-5959

Other names 1

  • North Shore Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
North Shore Medical Group10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281657600000",
    "number": "1003121013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PORTION RD",
            "address_2": "SUITE C",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117794172",
            "telephone_number": "631-585-5959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 PORTION RD",
            "address_2": "SUITE C",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117794172",
            "telephone_number": "631-585-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE MEDICAL GROUP OF MT SINAI SCHOOL OF MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-13",
        "last_updated": "2010-08-13",
        "status": "A",
        "authorized_official_last_name": "STREET",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "631-351-3703"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Ronkonkoma, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.