Organization
SOUTHSIDE HOSPITAL DEPARTMENT OF NEUROLOGY
Active
Parent organization
SOUTHSIDE HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHSIDE HOSPITAL
Authorized official
MS. WINIFRED MACK (CFO)
(631) 675-4149
Entity
Organization
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 968-3000
Mailing address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 968-3000
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01259347
—
NY
Enumeration date
05/05/2006
Last updated
10/09/2007
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