Provider Demographics
NPI:1285745299
Name:SEA SHORE RADIOLOGY, P.C.
Entity type:Organization
Organization Name:SEA SHORE RADIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-354-4200
Mailing Address - Street 1:1575 HILLSIDE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2501
Mailing Address - Country:US
Mailing Address - Phone:516-354-4200
Mailing Address - Fax:516-358-2825
Practice Address - Street 1:327 BEACH 19TH ST
Practice Address - Street 2:RADIOLOGY DEPT.
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4423
Practice Address - Country:US
Practice Address - Phone:718-869-7710
Practice Address - Fax:718-869-7192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00466959Medicaid
NY00466959Medicaid