Healthcare Provider Details

I. General information

NPI: 1235640210
Provider Name (Legal Business Name): SOUTH SHORE UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MAIN ST
BAY SHORE NY
11706-8408
US

IV. Provider business mailing address

1983 MARCUS AVE STE 118
NEW HYDE PARK NY
11042-1016
US

V. Phone/Fax

Practice location:
  • Phone: 631-894-5775
  • Fax: 631-894-5781
Mailing address:
  • Phone: 631-894-5775
  • Fax: 631-894-5781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number035763
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA DRUMMOND
Title or Position: SVP, CHIEF EXPENSE OFFICER
Credential:
Phone: 631-894-5775