Organization Active NPI

Wellcare Medical of North Shore

  • Pain Medicine Physician
  • Patchogue, NY
National Provider Identifier
1780310466
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
WELLCARE MEDICAL OF NORTH SHORE
Practice address
85 S Ocean Ave
Patchogue, NY 11772-3702
Phone
(631) 506-8907
Fax
(631) 506-8909
NPI assigned
Jul 26, 2022
Last updated
Dec 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Authorized official

Name
Evan B Shapiro, MDNPI 1164420493
Title
Owner
Phone
(516) 208-7600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X Primary

Addresses

Primary practice location

85 S Ocean Ave
Patchogue, NY 11772-3702

Mailing address

85 S Ocean Ave
Patchogue, NY 11772-3702
Phone (631) 506-8907

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1658793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1780310466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 S OCEAN AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723702",
            "telephone_number": "631-506-8907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 S OCEAN AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723702",
            "telephone_number": "631-506-8907",
            "fax_number": "631-506-8909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLCARE MEDICAL OF NORTH SHORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-26",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "EVAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-208-7600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "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 Dec 8, 2022; 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.