SOUTHSIDE HOSPITAL (NPI# 1235640210) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235640210 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE HOSPITAL |
| Other Organization Name | VIVO HEALTH PHARMACY AT SOUTHSIDE HOSPITAL |
| Practice Address |
301 E Main St Bay Shore NY 11706-8408 |
| Mailing Address |
3333 New Hyde Park Rd Ste 317 New Hyde Park NY 11042-1205 |
| Practice Telephone | 6318945775 |
| Practice Fax Number | 6318945776 |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2018-12-05 |
| Authorized Official Name | MRS. MICHELE LEE CUSACK (SENIOR VICE PRESIDENT & CFO) |
| Authorized Official Telephone | 5163216058 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
035763 | NY | Suppliers |
| Other Name | Type Code |
|---|---|
| Vivo Health Pharmacy at Southside Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851643704 | Southside Hospital | Anesthesiology | 301 E Main St, Bay Shore, NY 11706-8408 | 2012-10-02 |
| 1184798977 | Southside Hospital | Clinic/Center | 45 W Suffolk Ave, Central Islip, NY 11722-2143 | 2006-11-20 |
| 1457369381 | Southside Hospital | General Acute Care Hospital | 301 E Main St, Bay Shore, NY 11706-8408 | 2006-08-04 |
| 1366450298 | Southside Hospital | Psychiatric Unit | 301 E Main St, Bay Shore, NY 11706 | 2006-08-04 |
| 1275541104 | Southside Hospital | Rehabilitation Unit | 301 E Main St, Bay Shore, NY 11706-8408 | 2006-08-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | SOUTHSIDE HOSPITALITY INC. | 2815 N. Augusta St, Suite B, Staunton, Virginia 24401 |
| New York State Corporations | SOUTHSIDE HOSPITALITY LLC | 217 Havemeyer Street, 4th Floor, Brooklyn, Ny 11211 |
| Street Address |
301 E MAIN ST |
| City | BAY SHORE |
| State | NY |
| Zip Code | 11706-8408 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467053959 | Ebne Rafi | Pharmacist | 301 E Main St, Bay Shore, NY 11706-8408 | 2020-11-03 |
| 1154928711 | Brittany Lee Mulligan | Anesthesiology | 301 E Main St, Bay Shore, NY 11706-8408 | 2020-10-07 |
| 1093322786 | Aliesha Wahab | Pharmacist | 301 E Main St, Bay Shore, NY 11706-8458 | 2020-09-26 |
| 1316553795 | Erica Anne Schott | Pharmacist | 301 E Main St, Bay Shore, NY 11706-8408 | 2020-09-21 |
| 1780296913 | Chelsea Jensen | Physician Assistant | 301 E Main St, Bay Shore, NY 11706-8408 | 2020-08-19 |
| 1669081865 | John William Mcdonnell Jr. | Physician Assistant | 301 E Main St, Bay Shore, NY 11706-8408 | 2020-07-24 |
| 1205445566 | Michele Lisa Guelfi | Local Education Agency (LEA) | 301 E Main St, Bay Shore, NY 11706-8458 | 2020-07-23 |
| 1740899921 | Colleen Stubbs | Nurse Practitioner | 301 E Main St, Bay Shore, NY 11706-8458 | 2020-07-23 |
| 1063030757 | Rigoberto Ventura | Physician Assistant | 301 E Main St, Bay Shore, NY 11706-8408 | 2020-07-08 |
| 1780200709 | Valerie Brooke Matedero | Physician Assistant | 301 E Main St, Bay Shore, NY 11706-8408 | 2020-06-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598394173 | Erin Marie Barlow | Student in an Organized Health Care Education/Training Program | Southside Emergency Department 301 East Main Street, Bay Shore, NY 11706 | 2020-04-06 |
| 1003460890 | Bay Shore Brightwaters Rescue Ambulance Inc. | Ambulance | 911 Aletta Place, Bay Shore, NY 11706 | 2019-07-30 |
| 1861980872 | Raffy Gutman | Student in an Organized Health Care Education/Training Program | Southside Hospital Family Medicine, 301 E Main St, Bay Shore, NY 11706 | 2018-04-25 |
| 1609371004 | Sengal Kelit Alazar | Student in an Organized Health Care Education/Training Program | South Side Hospital Emergency Department - Northwell, 301 East Main Street, Bay Shore, NY 11706 | 2018-03-27 |
| 1780198671 | Stefany Gabriela Armijos | Social Worker | 144 Fifth Ave, Bay Shore, NY 11706 | 2017-11-30 |
| 1417476771 | Jazmin Unda Jimenez | Licensed Practical Nurse | 236 Adams Ave, Bay Shore, NY 11706 | 2017-09-18 |
| 1013436989 | People Pushers LLC | Non-emergency Medical Transport (VAN) | 50 Corbin Ave, Suite D, Bay Shore, NY 11706 | 2017-09-12 |
| 1871011585 | Life Acupuncture & Massage Therapy P.C. | Acupuncturist | 387 East Main Street Suite 104, Bayshore, NY 11706 | 2017-09-01 |
| 1558881458 | Wilda Novembre | Licensed Practical Nurse | 1742 North Thompson Drive, Bayshore, NY 11706 | 2017-06-21 |
| 1194184085 | Georgette Prawl | Nurse's Aide | 54 1st Avenue, Bayshore, NY 11706 | 2016-02-19 |
| Find all providers in zip 11706 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235230053 | Genovese Drug Stores Inc | Pharmacy | 599 E Main St, Bay Shore, NY 11706-8505 | 2006-09-26 |
| 1235236001 | Pathmark Stores Inc | Pharmacy | 2060 Sunrise Hwy, Bay Shore, NY 11706-6018 | 2006-09-20 |
| 1841478922 | Sun Ray Super Drugs Inc. | Pharmacy | 1191 Sunrise Hwy, Bay Shore, NY 11706 | 2008-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891396388 | Sharx Corp | Pharmacy | 4301 48th Ave, Woodside, NY 11377-6241 | 2020-11-03 |
| 1841890878 | Corner Pharmacy Myrtle | Pharmacy | 680 Myrtle Ave, Brooklyn, NY 11205-4119 | 2020-10-28 |
| 1124627302 | Elite Pharmacy Inc. | Pharmacy | 614a Grand St, Brooklyn, NY 11211-4802 | 2020-10-20 |
| 1073111951 | Pharmacy On Bay Street Inc. | Pharmacy | 1209 Bay St, Staten Island, NY 10305-3121 | 2020-10-13 |
| 1760080741 | Carol Pharmacy LLC | Pharmacy | 4230 Broadway, New York, NY 10033-3746 | 2020-10-13 |
| 1528666443 | Mvp Pharmacy Inc | Pharmacy | 920 Wheeler Rd Ste 920, Hauppauge, NY 11788-2900 | 2020-10-13 |
| 1477151512 | 101 Rx Pharmacy Inc | Pharmacy | 101 Rx Pharmacy Inc, 9718 101st Ave, Ozone Park, NY 11416 | 2020-10-12 |
| 1043818289 | Xuwei Lin | Pharmacy | 8218 14th Ave, Brooklyn, NY 11228-3114 | 2020-10-10 |
| 1043817463 | Angella Samson | Pharmacy | 1346 Granville Payne Ave, Brooklyn, NY 11239-2103 | 2020-10-08 |
| 1366059792 | Community Healthcare Network Inc. | Pharmacy | 999 Blake Ave Fl 1, Brooklyn, NY 11208-3535 | 2020-09-29 |
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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.