Healthcare Provider Details

I. General information

NPI: 1023102696
Provider Name (Legal Business Name): BAY SHORE FAMILY MEDICINE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 EAST MAIN ST SUITE 8
BAY SHORE NY
11706
US

IV. Provider business mailing address

19 EAST MAIN ST SUITE 8
BAY SHORE NY
11706
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-0760
  • Fax: 631-665-1886
Mailing address:
  • Phone: 631-665-0760
  • Fax: 631-665-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number162359
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number221368
License Number StateNY

VIII. Authorized Official

Name: STEVEN E KLEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 631-665-8515