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General NPI Number Information
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NPI Number | 1932420817
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE FAMILY MEDICINE,PC
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 2280 GRAND AVE SUITE 208
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City | BALDWIN
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State | NY
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Zip | 11510-3164
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Country | US
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Telephone | 516-623-4800
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Fax | 516-623-8845
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Provider Business Mailing Address
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Address Line | 2280 GRAND AVE SUITE 208
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City | BALDWIN
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State | NY
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Zip | 11510-3164
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Country | US
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Telephone | 516-623-4800
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Fax | 516-623-8845
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MARIE MARINO
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Credential |
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Telephone | 516-623-9675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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