MEDICARE: ROCKY POINT MEDICAL CARE, P.C.

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1134100316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY POINT MEDICAL CARE, P.C.

Provider Business Mailing Address
First Line	:	575 ROUTE 25A
Second Line	:
City	:	ROCKY POINT
State	:	NY
Zip	:	11778-8886
Country	:	US
Telephone Number	:	631-821-9000
Fax Number	:	631-821-9114

Provider Business Practice Location Address
First Line	:	575 ROUTE 25A
Second Line	:
City	:	ROCKY POINT
State	:	NY
Zip	:	11778-8886
Country	:	US
Telephone Number	:	631-821-9000
Fax Number	:	631-821-9114

Authorized Official
Title or Position	:	CO MANAGER
Name	:	DEBRA SUNDBERG
Credential	:
Telephone Number	:	631-821-9000

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	01/22/2010

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