Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
SOUTHSIDE HOSPITAL FACULTY PRACTICE
Active
Organization
SOUTHSIDE HOSPITAL FACULTY PRACTICE
Active
Parent organization
SOUTHSIDE HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHSIDE HOSPITAL
Authorized official
MS. WINIFRED MACK (CFO)
(631) 968-9000
Entity
Organization
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 675-4149
Mailing address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 675-4149
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02167655
—
NY
Enumeration date
04/26/2006
Last updated
08/13/2008
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up