Organization
SOUTHSIDE HOSPITAL EMERGENCY DEPARTMENT
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
207P00000X
Emergency Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01752496
—
NY
Enumeration date
04/26/2006
Last updated
10/09/2007
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