SOUTHSIDE HOSPITAL FACULTY PRACTICE NPI 1619934544

NPI Information

  • NPI: 1619934544
  • Provider Name: SOUTHSIDE HOSPITAL FACULTY PRACTICE
  • Classification: Internal Medicine - 207R00000X
  • Entity Type: Organization
  • Address: 301 E MAIN ST
    BAY SHORE, NY
    ZIP 11706
  • Phone: (631) 675-4149

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NPI Details

SOUTHSIDE HOSPITAL FACULTY PRACTICE is an internal medicine in Bay Shore, NY. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. SOUTHSIDE HOSPITAL FACULTY PRACTICE NPI is 1619934544. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

301 E MAIN ST
BAY SHORE, NY
ZIP 11706-408
Phone: (631) 675-4149

The provider's authorized official is Winifred Mack .
The authorized official title is Cfo and has the following contact phone number (631) 968-9000.

The enumeration date for this NPI number is 4/26/2006 and was last updated on 8/13/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyNo
2207Q00000XFamily MedicineNo
3363LA2200XNurse PractitionerAdult HealthNo
4208000000XPediatricsNo
5363A00000XPhysician AssistantNo
6207R00000XInternal MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
102167655MEDICAIDNEW YORK
2W79241MEDICARE PINNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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