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General NPI Number Information
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NPI Number | 1013268333
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE HEAD & NECK SURGERY MD., PC.
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 135 ROCKAWAY TURNPIKE SUITE 106
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City | LAWRENCE
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State | NY
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Zip | 11559-1023
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Country | US
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Telephone | 516-239-3225
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Fax | 516-764-3127
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Provider Business Mailing Address
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Address Line | 132 SEAMAN AVENUE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-3233
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Country | US
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Telephone | 516-764-3732
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Fax | 516-764-3127
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOO YOUNG JUN
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Credential | M.D.
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Telephone | 516-764-3732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 117557
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License Number State | NY
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