Basic Information
| Provider Information | |||||||||
| NPI: | 1356322101 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTH NASSAU COMMUNITIES HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE HEALTHY WAY | ||||||||
| Address2: | ATTN: PHYSICIAN BILLING | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162551600 | ||||||||
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| Practice Location | |||||||||
| Address1: | ONE HEALTHY WAY | ||||||||
| Address2: | ATTN: PHYSICIAN BILLING | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162551600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | BALKO | ||||||||
| AuthorizedOfficialFirstName: | ALEX | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT - FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 5166323965 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTH NASSAU COMMUNITIES HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.