NPIMap

Organization Active NPI

North Shore Medical Group of the Mount Sinai School of Medicine

Doing business as North Shore Medical Group

  • Gastroenterology Physician
  • Huntington, NY
National Provider Identifier
1164623278
Registry record updated Oct 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE
Doing business as
North Shore Medical Group
Practice address
775 Park Ave
Huntington, NY 11743-3976
Phone
(631) 659-4400
Fax
(631) 659-4578
NPI assigned
May 29, 2007
Last updated
Oct 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2015

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X
Procedural Dermatology Physician 207NS0135X
Gastroenterology Physician 207RG0100X Primary

Addresses

Primary practice location

775 Park Ave
Huntington, NY 11743-3976

Mailing address

775 Park Ave
Huntington, NY 11743-3976
Phone (631) 659-4400

Other names 1

  • North Shore Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040320000412 NY Part B Supplier - Clinic/Group Practice 8921999087 Receives reassigned benefits from 579 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2750 Merrick Rd
Bellmore, NY 11710
Phone (516) 409-2000

155 W Merrick Rd
Ste 101
Freeport, NY 11520
Phone (516) 379-3139

120 New York Ave
Huntington, NY 11743
Phone (631) 351-3766

Practitioners & affiliated clinicians

Practitioners 65

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1164623278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 PARK AVE",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117433976",
            "telephone_number": "631-659-4400",
            "fax_number": "631-659-4578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 PARK AVE",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117433976",
            "telephone_number": "631-659-4400",
            "fax_number": "631-659-4578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2015-10-06",
        "status": "A",
        "authorized_official_last_name": "STREET",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "631-351-3703"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "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 Huntington, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.