NPIMap

Organization Active NPI

North Shore Primary Care Medical Associates, PC

  • Internal Medicine Physician
  • New Hyde Park, NY
National Provider Identifier
1548287410
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
15517801 Issued in NY
Legal business name
NORTH SHORE PRIMARY CARE MEDICAL ASSOCIATES, PC
Practice address
1 Hollow LN Ste 109
New Hyde Park, NY 11042-1215
Phone
(516) 627-4433
Fax
(516) 627-0552
NPI assigned
Jul 16, 2006
Last updated
Aug 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

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

Authorized official

Name
David EdelsonNPI 1568440485
Title
President
Phone
(516) 627-4433

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
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 15517801 NY Primary

Addresses

Primary practice location

1 Hollow LN Ste 109
New Hyde Park, NY 11042-1215

Mailing address

1 Hollow LN Ste 109
New Hyde Park, NY 11042-1215
Phone (516) 627-4433

Other practice location 1

1000 Northern Blvd Ste 230
Great Neck, NY 11021-5341
Phone (516) 627-4433

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050901000948 NY Part B Supplier - Clinic/Group Practice 1456383165 Receives reassigned benefits from 8 practitioners
Practice locations: Great Neck, NY

National Provider Directory

National Provider Directory

Locations

1 Hollow Ln
Ste 109
New Hyde Park, NY 11042
Phone (516) 627-0552

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785974400000",
    "number": "1548287410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOLLOW LN STE 109",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421215",
            "telephone_number": "516-627-4433",
            "fax_number": "516-627-0552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOLLOW LN STE 109",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421215",
            "telephone_number": "516-627-4433",
            "fax_number": "516-627-0552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Northern Blvd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Great Neck",
            "state": "NY",
            "postal_code": "110215341",
            "country_code": "US",
            "telephone_number": "516-627-4433",
            "fax_number": "516-627-0552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTH SHORE PRIMARY CARE MEDICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A",
        "authorized_official_last_name": "EDELSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-627-4433"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "15517801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Hyde Park, NY

Sources for this page

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