Healthcare Provider Details

I. General information

NPI: 1700578754
Provider Name (Legal Business Name): SYOSSET FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 JERICHO TPKE STE LE
SYOSSET NY
11791-4489
US

IV. Provider business mailing address

6500 JERICHO TPKE STE LE
SYOSSET NY
11791-4489
US

V. Phone/Fax

Practice location:
  • Phone: 845-593-2236
  • Fax: 845-593-2237
Mailing address:
  • Phone: 845-593-2236
  • Fax: 845-593-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHEN-HAN LIN
Title or Position: CEO
Credential: DO
Phone: 516-509-8499