NPIMap

Organization Active NPI

North Shore Medical Group of Mt Sinai School of Medicine

Doing business as North Shore Medical Group

  • Pediatric Urology Physician
  • Huntington, NY
National Provider Identifier
1639317043
Registry record updated Jan 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
Legal business name
NORTH SHORE MEDICAL GROUP OF MT SINAI SCHOOL OF MEDICINE
Doing business as
North Shore Medical Group
Practice address
21 Southdown Rd
Huntington, NY 11743-2538
Phone
(631) 351-3763
Fax
(631) 385-8210
NPI assigned
Jan 23, 2009
Last updated
Jan 23, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2009

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology Physician 2088P0231X NU Primary

Addresses

Primary practice location

21 Southdown Rd
Huntington, NY 11743-2538

Mailing address

21 Southdown Rd
Huntington, NY 11743-2538
Phone (631) 351-3763

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

NPI Registry JSON

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

{
    "created_epoch": "1232668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232668800000",
    "number": "1639317043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 SOUTHDOWN RD",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117432538",
            "telephone_number": "631-351-3763",
            "fax_number": "631-385-8210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 SOUTHDOWN RD",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117432538",
            "telephone_number": "631-351-3763",
            "fax_number": "631-385-8210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE MEDICAL GROUP OF MT SINAI SCHOOL OF MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-23",
        "last_updated": "2009-01-23",
        "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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "NU",
            "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 Jan 23, 2009; 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.