Provider Demographics
NPI:1104262088
Name:HEART HEALTH OF THE SOUTH SHORE PC
Entity type:Organization
Organization Name:HEART HEALTH OF THE SOUTH SHORE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-218-2510
Mailing Address - Street 1:949 CENTRAL AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1204
Mailing Address - Country:US
Mailing Address - Phone:516-218-2510
Mailing Address - Fax:516-341-7077
Practice Address - Street 1:949 CENTRAL AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1204
Practice Address - Country:US
Practice Address - Phone:516-218-2510
Practice Address - Fax:516-341-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236218207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty