Provider Demographics
NPI:1144538331
Name:NORTH SHORE VASCULAR AND ENDOVASCULAR PLLC
Entity type:Organization
Organization Name:NORTH SHORE VASCULAR AND ENDOVASCULAR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-328-9800
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE S50
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-328-9800
Mailing Address - Fax:516-328-9801
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE S50
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-328-9800
Practice Address - Fax:516-328-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1950382086S0129X
NY2070672086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty