Southside Hospital Emergency Department

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

SOUTHSIDE HOSPITAL EMERGENCY DEPARTMENT

Practice address

301 E Main St
Bay Shore, NY 11706-8408

Phone

(631) 675-4149

NPI assigned

Apr 26, 2006

Organization subpart

Yes

Parent organization

SOUTHSIDE HOSPITALAs reported in NPPES

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

Authorized official

Name

Ms. Winifred Mack

Title

Cfo

Phone

(631) 968-9000

Specialties & licenses 4

Addresses

Other identifiers 1

Part of

Southside Hospital HHA

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1528025459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068408",
            "telephone_number": "631-675-4149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068408",
            "telephone_number": "631-675-4149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE HOSPITAL EMERGENCY DEPARTMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHSIDE HOSPITAL",
        "enumeration_date": "2006-04-26",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "WINIFRED",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "631-968-9000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01752496",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southside Hospital
• Southside Hospital Department of Cardiology
• Southside Hospital Department of Neurology
• Southside Hospital Department of Pathology
• Southside Hospital Department of Psychiatry
• Southside Hospital Faculty Practice
• Jaclyn Spiegel, PSY.D.
• Rex Spielmann, MD
• Richard Frank Spinello
• Peter Alex Spiratos

• Emergency Medicine Physician in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Emergency Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; 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.