Provider Demographics
NPI:1962889345
Name:NORTH SHORE VASCULAR SURGERY, PC
Entity type:Organization
Organization Name:NORTH SHORE VASCULAR SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VASCULAR SURGEON / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:F
Authorized Official - Last Name:BHATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, RVT, FACS
Authorized Official - Phone:631-805-5956
Mailing Address - Street 1:620 BELLE TERRE RD
Mailing Address - Street 2:SUITE NO. 2
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2500
Mailing Address - Country:US
Mailing Address - Phone:631-524-5960
Mailing Address - Fax:631-524-5963
Practice Address - Street 1:620 BELLE TERRE RD
Practice Address - Street 2:SUITE NO. 2
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2500
Practice Address - Country:US
Practice Address - Phone:631-524-5960
Practice Address - Fax:631-524-5963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1598783953Medicare PIN