NPIMap

Organization Active NPI

Evergreen Ear, Nose & Throat Surgery P.C.

  • Otolaryngology Physician
  • Long Beach, NY
National Provider Identifier
1982622817
Registry record updated Apr 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
EVERGREEN EAR, NOSE & THROAT SURGERY P.C.
Practice address
728 E Park Ave
Long Beach, NY 11561-2605
Phone
(516) 431-0700
Fax
(516) 706-0622
NPI assigned
Jul 18, 2006
Last updated
Apr 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2016

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

Authorized official

Name
Dr. Shefali Shah, M.D.NPI 1568484020
Title
President
Phone
(516) 431-0700

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
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

728 E Park Ave
Long Beach, NY 11561-2605

Mailing address

34 Farm LN
Great Neck, NY 11020-1314
Phone (516) 581-5099

National Provider Directory

National Provider Directory

Locations

877 Stewart Ave
Ste 16
Garden City, NY 11530
Phone (516) 431-0700

480 E Bay Dr
Long Beach, NY 11561
Phone (516) 431-0700

22414 147th Ave
Sprngfld Gdns, NY 11413
Phone (718) 723-5010

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": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460505600000",
    "number": "1982622817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 FARM LN",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110201314",
            "telephone_number": "516-581-5099",
            "fax_number": "516-706-0622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "728 E PARK AVE",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "115612605",
            "telephone_number": "516-431-0700",
            "fax_number": "516-706-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN EAR, NOSE & THROAT SURGERY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2016-04-13",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "SHEFALI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-431-0700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2016; 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.