Healthcare Provider Details

I. General information

NPI: 1841119765
Provider Name (Legal Business Name): CS MEDICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 JOSHUAS PATH
HAUPPAUGE NY
11788-4812
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 102
ISLANDIA NY
11749-5249
US

V. Phone/Fax

Practice location:
  • Phone: 631-696-4357
  • Fax:
Mailing address:
  • Phone: 631-696-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACEY WALLACE
Title or Position: VP OPS
Credential:
Phone: 631-696-4357