Basic Information
| Provider Information | |||||||||
| NPI: | 1467582742 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ORTHOPAEDIC ASSOCIATES OF GREAT NECK,LLP | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 825 NORTHERN BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167737500 | ||||||||
| FaxNumber: | 5167737575 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 NORTHERN BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167737500 | ||||||||
| FaxNumber: | 5167737595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 01/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | SIMONSON | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | GLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5167737500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 104208 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.