Healthcare Provider Details

I. General information

NPI: 1285223248
Provider Name (Legal Business Name): SOUTH ISLAND ORTHOPEDICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 FROEHLICH FARM BLVD
WOODBURY NY
11797-2931
US

IV. Provider business mailing address

657 CENTRAL AVE
CEDARHURST NY
11516-2320
US

V. Phone/Fax

Practice location:
  • Phone: 516-364-0070
  • Fax: 978-313-8511
Mailing address:
  • Phone: 516-295-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC L FREEMAN
Title or Position: OWNER
Credential: MD
Phone: 516-295-0111