NPIMap

Organization Active NPI

South Shore Neurologic Associates, PC

  • Durable Medical Equipment & Medical Supplies
  • Patchogue, NY
National Provider Identifier
1700183373
Registry record updated May 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
1313140002 Issued in NY
Legal business name
SOUTH SHORE NEUROLOGIC ASSOCIATES, PC
Practice address
77 Medford Avenue
Route 112
Patchogue, NY 11772
Phone
(631) 758-1910
Fax
(631) 730-3467
NPI assigned
Feb 17, 2011
Last updated
May 4, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH SHORE NEUROLOGIC ASSOCIATES PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 4, 2011

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

Authorized official

Name
Mrs. Angela Deritis
Title
Billing Manager
Phone
(631) 758-4444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1313140002 NY Primary

Addresses

Primary practice location

77 Medford Avenue
Route 112
Patchogue, NY 11772

Mailing address

77 Medford Avenue
Route 112
Patchogue, NY 11772
Phone (631) 758-1910

National Provider Directory

National Provider Directory
Part of
Norman L Chernik

Locations

77 Medford Ave
#112
Patchogue, NY 11772
Phone (631) 758-1910

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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": "1297900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304467200000",
    "number": "1700183373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 MEDFORD AVENUE",
            "address_2": "ROUTE 112",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "11772",
            "telephone_number": "631-758-1910",
            "fax_number": "631-730-3467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 MEDFORD AVENUE",
            "address_2": "ROUTE 112",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "11772",
            "telephone_number": "631-758-1910",
            "fax_number": "631-730-3467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE NEUROLOGIC ASSOCIATES, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH SHORE NEUROLOGIC ASSOCIATES PC",
        "enumeration_date": "2011-02-17",
        "last_updated": "2011-05-04",
        "status": "A",
        "authorized_official_last_name": "DERITIS",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "631-758-4444",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "1313140002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Patchogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; 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.