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General NPI Number Information
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NPI Number | 1578563714
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Entity Type | Organization
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Legal Business Name | BAY SHORE FAMILY MEDICAL CARE PC
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 2915 SUNRISE HWY
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City | ISLIP TERRACE
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State | NY
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Zip | 11752-2716
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Country | US
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Telephone | 631-446-1006
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Fax | 631-446-1009
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Provider Business Mailing Address
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Address Line | 2915 SUNRISE HWY
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City | ISLIP TERRACE
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State | NY
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Zip | 11752-2716
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Country | US
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Telephone | 631-446-1006
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Fax | 631-446-1009
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Authorized Official
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Title or Position | SUPERVISING PHYSICIAN
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Name | DR. NELSON R GIRALDO
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Credential | M.D.
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Telephone | 631-665-8006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 175993-1
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License Number State | NY
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