Organization Active NPI

North Shore Infectious Diseases Consultants, PC

  • Infectious Disease Physician
  • Greenvale, NY
National Provider Identifier
1114974094
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
NORTH SHORE INFECTIOUS DISEASES CONSULTANTS, PC
Practice address
2200 Northern Blvd Ste 205
Greenvale, NY 11548-1220
Phone
(516) 767-7771
Fax
(516) 767-7765
NPI assigned
May 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Angie Rodriguez
Title
Practice Administrator
Phone
(516) 767-7771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

2200 Northern Blvd Ste 205
Greenvale, NY 11548-1220

Mailing address

2200 Northern Blvd Ste 205
Greenvale, NY 11548-1220
Phone (516) 767-7771

Other identifiers 1

IdentifierTypeStateIssuer
01175960MedicaidNY

National Provider Directory

National Provider Directory

Locations

44 S Bayles Ave
#216
Port Washington, NY 11050
Phone (516) 767-7771

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1114974094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 NORTHERN BLVD STE 205",
            "city": "GREENVALE",
            "state": "NY",
            "postal_code": "115481220",
            "telephone_number": "516-767-7771",
            "fax_number": "516-767-7765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NORTHERN BLVD STE 205",
            "city": "GREENVALE",
            "state": "NY",
            "postal_code": "115481220",
            "telephone_number": "516-767-7771",
            "fax_number": "516-767-7765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE INFECTIOUS DISEASES CONSULTANTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "516-767-7771"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01175960",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenvale, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; 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.