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General NPI Number Information
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NPI Number | 1023318623
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE MEDICAL SUPPLY
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 831 KINGS PKWY
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-2124
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Country | US
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Telephone | 516-444-1958
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Fax |
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Provider Business Mailing Address
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Address Line | 831 KINGS PKWY
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-2124
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. THOMAS OYOR EGWABOR
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Credential |
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Telephone | 516-444-1958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1213904
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License Number State | NY
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