Healthcare Provider Details

I. General information

NPI: 1588393656
Provider Name (Legal Business Name): MEDICAL SERVICES OF BELLMORE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-4400
  • Fax:
Mailing address:
  • Phone: 718-470-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHELE L CUSACK
Title or Position: SENIOR VICE PRESIDENT & CFO
Credential:
Phone: 516-321-6058