Healthcare Provider Details

I. General information

NPI: 1851452023
Provider Name (Legal Business Name): ISLAND MUSCULOSKELETAL CARE, M.D., P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22414 MERRICK BLVD
LAURELTON NY
11413-2023
US

IV. Provider business mailing address

PO BOX 360
HEWLETT NY
11557-9998
US

V. Phone/Fax

Practice location:
  • Phone: 718-850-6577
  • Fax: 718-850-6581
Mailing address:
  • Phone: 516-374-6838
  • Fax: 516-374-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name: BARRY D JUPITER
Title or Position: MD
Credential:
Phone: 516-374-6838