Healthcare Provider Details

I. General information

NPI: 1194377465
Provider Name (Legal Business Name): SOUTH ISLAND ORTHOPEDICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/22/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 CENTRAL AVE
CEDARHURST NY
11516-2320
US

IV. Provider business mailing address

50 CHARLES LINDBERGH BLVD STE 103
UNIONDALE NY
11553-3654
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-0111
  • Fax:
Mailing address:
  • Phone: 516-294-4590
  • Fax: 978-313-8551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC FREEMAN
Title or Position: OWNER
Credential: MD
Phone: 516-295-0111