NPIMap

Organization Active NPI

Shore Medical Treatment PLLC

  • Specialist
  • Jericho, NY
National Provider Identifier
1457016669
Registry record updated Jun 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SHORE MEDICAL TREATMENT PLLC
Practice address
350 Jericho Tpke Ste 310
Jericho, NY 11753-1317
Phone
(631) 450-3772
Fax
(212) 561-5530
NPI assigned
Nov 2, 2021
Last updated
Jun 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2026

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

Authorized official

Name
Dr. Michael Nguyen, MDNPI 1730380478
Title
Owner
Phone
(332) 282-5622

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

350 Jericho Tpke Ste 310
Jericho, NY 11753-1317

Mailing address

244 Madison Ave # 165
New York, NY 10016-2817
Phone (631) 450-3772

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220127000934 NY Part B Supplier - Clinic/Group Practice 7810389715 Receives reassigned benefits from 10 practitioners
Practice locations: Hampton Bays, NY; Jericho, NY; Port Jefferson, NY; Rockville Centre, NY; West Islip, NY

National Provider Directory

National Provider Directory

Locations

350 Jericho Tpke
Ste 1A
Jericho, NY 11753
Phone (212) 518-4562

350 Jericho Tpke
Ste 310
Jericho, NY 11753
Phone (212) 470-6676

244 Madison Ave
#165
New York, NY 10016

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780444800000",
    "number": "1457016669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 MADISON AVE # 165",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100162817",
            "telephone_number": "631-450-3772",
            "fax_number": "212-561-5530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 JERICHO TPKE STE 310",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117531317",
            "telephone_number": "631-450-3772",
            "fax_number": "212-561-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE MEDICAL TREATMENT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-02",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "332-282-5622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jericho, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; 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.