Healthcare Provider Details

I. General information

NPI: 1801896998
Provider Name (Legal Business Name): SOUTH SHORE RADIATION ONCOLOGY ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

PO BOX 10266
UNIONDALE NY
11555-0266
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-3303
  • Fax:
Mailing address:
  • Phone: 516-632-3303
  • Fax: 516-632-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. EDWARD MULLEN
Title or Position: PHYSICIAN
Credential: MD
Phone: 516-632-3380