| Organization Name: | NORTH SHORE LIJ MEDICAL GROUP URGENT MEDICAL CARE, P.C |
| NPI Number: | 1033536297 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BOYD FAUST (CFO / COO) |
| Mailing Address: | 145 Community Dr Great Neck |
| State: | NY US |
| Postal Code: | 110215502 |
| Phone Number: | 6503877575 |
| Fax Number: | |
| NPI Enumeration Date: | 03/26/2014 |
| NPI Last Update Date: | 03/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |