South Nassau Obstetrics & Gynecology, PC

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

Legal business name

SOUTH NASSAU OBSTETRICS & GYNECOLOGY, PC

Practice address

1 S Central Ave
Valley Stream, NY 11580-5443

Phone

(516) 632-3350

NPI assigned

May 22, 2012

Last updated

Mar 25, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

SOUTH NASSAU COMMUNITIES HOSPITALAs reported in NPPES

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

Authorized official

Name

Mark Bogen

Title

Cfo

Phone

(516) 632-3965

Specialties & licenses 1

Addresses

Part of

So Nassau Com Hosp ER

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427241600000",
    "number": "1043570286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HEALTHY WAY",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115721551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S CENTRAL AVE",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115805443",
            "telephone_number": "516-632-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH NASSAU OBSTETRICS & GYNECOLOGY, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH NASSAU COMMUNITIES HOSPITAL",
        "enumeration_date": "2012-05-22",
        "last_updated": "2015-03-25",
        "status": "A",
        "authorized_official_last_name": "BOGEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "516-632-3965"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dariel Smuckler, PEER SPECIALIST
• Casey Marie Smyth
• Anna Snapp
• Ji Sun Song, NP
• South Central Dental Implant PLLC
• South Nassau Orthopedic Surgery and Sports Medicine, P.C.
• South Nassau Physician Practice PC
• South Nassau Physicians PC
• South Shore Diagnostics, Inc.
• South Shore Opticians Inc

• Gynecology Physician in Valley Stream, NY
• Providers in Valley Stream, NY by specialty
• Gynecology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; 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.