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Organization
SOUTHSIDE HOSPITAL
Active
Organization
SOUTHSIDE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT S SHAPIRO (EXECUTIVE VP AND CFO)
(516) 465-8182
Entity
Organization
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 422-6166
(631) 422-6269
Mailing address
PO BOX 417683, BOSTON, MA 02241-7640
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
10/02/2012
Last updated
10/02/2012
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