Provider Demographics
NPI:1962697490
Name:VETERANS ADMINISTRATION HOSPITAL
Entity type:Organization
Organization Name:VETERANS ADMINISTRATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:XIYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-940-8711
Mailing Address - Street 1:15 JEAN PL
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5914
Mailing Address - Country:US
Mailing Address - Phone:516-558-7900
Mailing Address - Fax:
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2200
Practice Address - Country:US
Practice Address - Phone:631-261-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245201261QA0005X, 261QA0600X, 275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit