Provider Demographics
NPI:1174004477
Name:NORTH SHORE ANESTHESIA GROUP
Entity type:Organization
Organization Name:NORTH SHORE ANESTHESIA GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDA-A, FASMLAP
Authorized Official - Phone:631-987-9643
Mailing Address - Street 1:15 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4902
Mailing Address - Country:US
Mailing Address - Phone:631-987-9643
Mailing Address - Fax:
Practice Address - Street 1:11-52 ENGINEERS ST
Practice Address - Street 2:
Practice Address - City:HAUPPHAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-987-9643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
533OtherDOH DISPOSITION CODE