North Shore Complete Medical PC
Internal Medicine, Cardiovascular Disease in Manhasset, NY. Organization (NPI-2).
NPI number1164042156
StatusActive
Last updated in NPPESApr 20, 2020
Details
- NPI
- 1164042156
- Entity type
- Organization (NPI-2)
- Legal business name
- North Shore Complete Medical PC
- Organization subpart
- No
- Enumeration date
- Apr 20, 2020
- Certification date
- Apr 20, 2020
- Last updated
- Apr 20, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RC0000X | Internal Medicine, Cardiovascular Disease | – | – | Yes |
Practice location
300 Community DrManhasset, NY 11030-3816
Phone 516-403-9104
Mailing address
40 Red Brook RdGreat Neck, NY 11024-1439
Phone 516-403-9104
Authorized official
Omid Javdan
MD
5164039104
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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