DR. EDWARD J MACK (NPI# 1134148836) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134148836 |
| Entity Type | Individual |
| Full Name | DR. EDWARD J MACK |
| Credential | MD |
| Practice Address |
79 Middleville Road Chief of Staff Office(11) Northport NY 11768 |
| Mailing Address |
79 Middleville Road Northport Vamc, Chief of Staff Office(11) Northport NY 11768 |
| Practice Telephone | 6312614400 |
| Mailing Telephone | 6312614400 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
131445 | NY | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457485492 | Edward Maurice Mack | Dentist | 5180 Park Ave, Suite 300, Memphis, TN 38119-3521 | 2007-03-14 |
| 1245338110 | Edward C. Mack | Internal Medicine | 315 Boulevard Ne, Suite 444, Atlanta, GA 30312-1200 | 2006-09-21 |
| Street Address |
79 MIDDLEVILLE ROAD CHIEF OF STAFF OFFICE(11) |
| City | NORTHPORT |
| State | NY |
| Zip Code | 11768 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619936671 | Bharat R Shah | Urology | 79 Middleville Road, Northport, NY 11768-2290 | 2006-03-20 |
| 1881941375 | Heidi Lary Kar | Psychologist | 79 Middleville Road, Va Medical Center, Psychology Service, #116b, Northport, NY 11768 | 2012-08-14 |
| 1841569514 | Jolienne Adria Walters-harvey | Nurse Practitioner | 79 Middleville Road, Department of Veterans Affairs, Northport, NY 11768 | 2011-12-23 |
| 1396060802 | Jamsheed Rasheed Memon | Student in an Organized Health Care Education/Training Program | 79 Middleville Road, Dept of Veterans Affairs, Northport, NY 11768 | 2010-03-29 |
| 1104059823 | Pranav Hemant Patel | Pediatrics | 79 Middleville Road, Northport, NY 11768 | 2009-08-27 |
| 1962654657 | Tracy Anne French | Psychologist | 79 Middleville Road, Northport Vamc Psychology 116b, Northport, NY 11768 | 2008-10-14 |
| 1063676773 | Enrique Pastoriza-munoz | Internal Medicine | 79 Middleville Road, Va Medical Center - 111r, Northport, NY 11768 | 2008-07-11 |
| 1780802686 | James Conrad Fleischmann | Counselor | 79 Middleville Road, Northport, NY 11768 | 2007-04-23 |
| 1245364975 | Jeffrey Stuart Gold | Psychiatry & Neurology | 79 Middleville Road, Northport, NY 11768 | 2007-03-15 |
| 1265522783 | Robert Mendez | Counselor | 79 Middleville Road, Department of Veterans Affairs Medical Center, Northport, NY 11768-2290 | 2006-10-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649753088 | Tania Morris | Developmental Therapist | 130 Main St, #1, Northport, Ny 11768, Northport, NY 11768 | 2018-09-12 |
| 1639698343 | Karen Yuan Wong | Student in an Organized Health Care Education/Training Program | 79 Middleviille Rd., Optometry 123, Northport, NY 11768 | 2017-09-13 |
| 1821514795 | Village Speech and Language Pllc | Clinic/Center | 62 Makamah Beach Rd, Northport, NY 11768 | 2017-08-22 |
| 1073960415 | Dennis Falco | Private Vehicle | 5 Captain Richards Ln, Fort Salonga, NY 11768 | 2016-05-16 |
| 1679938252 | Debra Marie Failla | Psychologist | 260 Main Street, Suite 202, Northport, NY 11768 | 2015-12-23 |
| 1649649096 | Lillian Patricia Fais | Specialist | 26 Josephine Lane, Fort Salonga, NY 11768 | 2015-09-16 |
| 1427349505 | Kathleen Ann Korwasky | Occupational Therapist | 18 Dick Court, Northport, NY 11768 | 2011-04-25 |
| 1043448822 | Gianna Rose Ferranti | Dentist | 19 Winkle Point Road, Northport, NY 11768 | 2009-06-30 |
| 1861658213 | Barbara Ann Hansen | Registered Nurse | 78 Eatons Neck Rd, Northport, NY 11768 | 2008-08-05 |
| 1902060148 | Dana Ruth Cohen | Psychiatry & Neurology | 79 Middleville Road, Bldg 64, Northport Vamc, Northport, NY 11768 | 2008-07-16 |
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| Taxonomy Code | 207RG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Geriatric Medicine |
| An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538112768 | Linda Marie Honkanen | Internal Medicine | 79 Middleville Rd, Northport, NY 11768-2200 | 2006-05-18 |
| 1437112208 | Sabahat Mahmood | Internal Medicine | Veterans Affairs Medical Center, 79 Middleville Rd, Northport, NY 11768 | 2006-04-11 |
| 1821051798 | Shing-shing Yeh | Internal Medicine | 79 Middleville Rd, Dept. of Medicine, 11ec, Northport, NY 11768-2200 | 2006-04-10 |
| 1225090582 | Joanne Julia Holland | Internal Medicine | 79 Middleville Rd, Medicine (111) Vamc, Northport, NY 11768-2200 | 2006-04-03 |
| 1811961766 | Younghee J Limb | Internal Medicine | 79 Middleville Rd, Northport Vamc, Northport, NY 11768-2200 | 2006-02-16 |
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| 1487027496 | Shujing Lin | Internal Medicine | 6309 New Utrecht Ave, Brooklyn, NY 11219-5425 | 2015-11-12 |
| 1073980744 | Young Soo Lee | Internal Medicine | 211 E 13th St, 4e, New York, NY 10003-5691 | 2015-08-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.