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General NPI Number Information
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NPI Number | 1669075651
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Entity Type | Organization
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Legal Business Name | MEDICAL SERVICES OF KIPS BAY PC
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Dates
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Enumeration Date | 11/20/2020
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 170 GREAT NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11021-3357
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Country | US
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Telephone | 516-487-4464
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Fax | 516-487-4980
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Provider Business Mailing Address
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Address Line | 325 E MAIN ST
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City | PATCHOGUE
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State | NY
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Zip | 11772-3114
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Country | US
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Telephone | 516-358-8100
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Fax | 631-654-1474
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT & CFO
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Name | MRS. MICHELE L CUSACK
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Credential |
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Telephone | 516-321-6058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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