South Nassau Pediatrics,LLP

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

087868 Issued in NY

Legal business name

SOUTH NASSAU PEDIATRICS,LLP

Practice address

55 N Ocean Ave
Freeport, NY 11520-3035

Phone

(516) 379-1535

Fax

(516) 223-4962

NPI assigned

Oct 10, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Andrew Lewis Ageloff, M.D.

Title

Administrator

Phone

(516) 379-1535

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Kathleen Ann Devarso, CPNP

  • Pediatric Nurse Practitioner
  • Freeport, NY
  • NPI 1972691707
  NPD (past)
• Suanne Kowal-Connelly, M.D.

  • Pediatric Adolescent Medicine Physician
  • Freeport, NY
  • NPI 1427146042
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356439145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 N OCEAN AVE",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115203035",
            "telephone_number": "516-379-1535",
            "fax_number": "516-223-4962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 N OCEAN AVE",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115203035",
            "telephone_number": "516-379-1535",
            "fax_number": "516-223-4962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH NASSAU PEDIATRICS,LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AGELOFF",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "LEWIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "516-379-1535",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "087868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00351395",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shayiah P Smith
• Shurland E Smith
• Vanessa Sobers
• Jennifer Sommermann, LCMT
• South Nassau Internal Medicine Associates, LLP
• South Nassau Urology, PC
• South Ocean Care LLC
• South Shore Child Association Incorporated
• South Shore Child Association Incorporated
• South Shore Guidance Center

• Pediatrics Physician in Freeport, NY
• Providers in Freeport, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.