Provider Demographics
NPI:1285607069
Name:NORTH SHORE INTERNAL MEDICINE, PC
Entity type:Organization
Organization Name:NORTH SHORE INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:GIACOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-473-3900
Mailing Address - Street 1:9 MEDICAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1591
Mailing Address - Country:US
Mailing Address - Phone:631-473-3900
Mailing Address - Fax:631-474-4475
Practice Address - Street 1:9 MEDICAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1591
Practice Address - Country:US
Practice Address - Phone:631-473-3900
Practice Address - Fax:631-474-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWP541Medicare PIN