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NPI Code Detail

MEDICARE: SOUTH SHORE RADIATION ONCOLOGY ASSOCIATES P C

MEDICARE: SOUTH SHORE RADIATION ONCOLOGY ASSOCIATES P C
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
12085R0001XRadiation Oncology PhysicianNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801896998
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH SHORE RADIATION ONCOLOGY ASSOCIATES P C
Provider Business Mailing Address
First Line : PO BOX 10266
Second Line :
City : UNIONDALE
State : NY
Zip : 11555-0266
Country : US
Telephone Number : 516-632-3303
Fax Number : 516-632-3325
Provider Business Practice Location Address
First Line : 1 HEALTHY WAY
Second Line :
City : OCEANSIDE
State : NY
Zip : 11572-1551
Country : US
Telephone Number : 516-632-3303
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : DR. EDWARD MULLEN
Credential : MD
Telephone Number : 516-632-3380
Provider Enumeration Date : 07/29/2005
Last Update Date : 07/21/2022

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