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NPI Code Detail

MEDICARE: BAY SHORE FAMILY MEDICAL CARE PC

MEDICARE: BAY SHORE FAMILY MEDICAL CARE PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center175993-1NY

General Provider Information

NPI Number : 1578563714
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAY SHORE FAMILY MEDICAL CARE PC
Provider Business Mailing Address
First Line : 2915 SUNRISE HWY
Second Line :
City : ISLIP TERRACE
State : NY
Zip : 11752-2716
Country : US
Telephone Number : 631-446-1006
Fax Number : 631-446-1009
Provider Business Practice Location Address
First Line : 2915 SUNRISE HWY
Second Line :
City : ISLIP TERRACE
State : NY
Zip : 11752-2716
Country : US
Telephone Number : 631-446-1006
Fax Number : 631-446-1009
Authorized Official
Title or Position : SUPERVISING PHYSICIAN
Name : DR. NELSON R GIRALDO
Credential : M.D.
Telephone Number : 631-665-8006
Provider Enumeration Date : 07/29/2005
Last Update Date : 05/04/2010

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Directions to “BAY SHORE FAMILY MEDICAL CARE PC ” Practice Location

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