MEDICARE: SELECT PHYSICIANS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	60-131327	NY

General Provider Information

NPI Number	:	1043244015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELECT PHYSICIANS, PC

Provider Business Mailing Address
First Line	:	410 LAKEVILLE RD STE 200
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1103
Country	:	US
Telephone Number	:	516-488-9700
Fax Number	:	516-488-5128

Provider Business Practice Location Address
First Line	:	410 LAKEVILLE RD STE 200
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1103
Country	:	US
Telephone Number	:	516-488-9700
Fax Number	:	516-488-5128

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. O'NEALL E PARRIS
Credential	:	M.D.
Telephone Number	:	516-488-9700

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/22/2020

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