South Nassau Physicians PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

SOUTH NASSAU PHYSICIANS PC

Practice address

1 S Central Ave
Valley Stream, NY 11580-5443

Phone

(516) 632-3350

NPI assigned

Jul 15, 2015

Organization subpart

No

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

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paolo A Bolognese, M.D.

  • Neurological Surgery Physician
  • New Hyde Park, NY
  • NPI 1154492148
  Medicare reassignment NPD

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436918400000",
    "number": "1104200641",
    "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 PHYSICIANS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-15",
        "last_updated": "2015-07-15",
        "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": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ji Sun Song, NP
• South Central Dental Implant PLLC
• South Nassau Obstetrics & Gynecology, PC
• South Nassau Orthopedic Surgery and Sports Medicine, P.C.
• South Nassau Physician Practice PC
• South Shore Diagnostics, Inc.
• South Shore Opticians Inc
• Southwest Medical Imaging, PC
• Southwest Nassau Radiology, PC
• Alexa Jade Sparacio, PA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.