| North Shore Medical Pllc | |
|
21008 Northern Blvd Suit 1a Bayside NY 11361-3211 | |
| (718) 281-0833 | |
| (718) 281-0566 |
| Full Name | North Shore Medical Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 21008 Northern Blvd, Bayside, New York |
| Authorized Official Name and Position | Marvin Base (DIRECTOR) |
| Authorized Official Contact | 7188061434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Shore Medical Pllc 65-11 Booth Street Suite 1c Rego Park NY 11374 Ph: (718) 806-1434 | North Shore Medical Pllc 21008 Northern Blvd Suit 1a Bayside NY 11361-3211 Ph: (718) 281-0833 |
| NPI Number | 1083966170 |
|---|---|
| Provider Enumeration Date | 10/12/2012 |
| Last Update Date | 01/08/2014 |
| Medicare PECOS PAC ID | 9234384561 |
|---|---|
| Medicare Enrollment ID | O20130312000401 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083966170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 187770 (New York) | Primary |
| Provider Name | Marvin Base |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366401853 PECOS PAC ID: 2769586528 Enrollment ID: I20070404000052 |
| Provider Name | Md A Rahman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982990495 PECOS PAC ID: 6103147236 Enrollment ID: I20150602000504 |
| Provider Name | Darya Blednova |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023451010 PECOS PAC ID: 5092001941 Enrollment ID: I20160901001899 |
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