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General NPI Number Information
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NPI Number | 1992731426
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Entity Type | Organization
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Legal Business Name | NORTH SHORE MEDICAL CARE, P.C.
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 399 FORT SALONGA RD
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City | NORTHPORT
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State | NY
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Zip | 11768-3045
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Country | US
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Telephone | 631-757-5400
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Fax | 631-757-4178
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Provider Business Mailing Address
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Address Line | 399 FORT SALONGA RD
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City | NORTHPORT
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State | NY
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Zip | 11768-3045
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Country | US
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Telephone | 631-757-5400
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Fax | 631-757-4178
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROBERT E. SCULLY
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Credential | MD
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Telephone | 631-757-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 164326
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License Number State | NY
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