MEDICARE: ISLAND MUSCULOSKELETAL CARE, M.D., P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	111N00000X	Chiropractor	NY
2	208100000X	Physical Medicine & Rehabilitation Physician	NY
3	2084N0400X	Neurology Physician	NY
4	2085R0202X	Diagnostic Radiology Physician	NM
5	225100000X	Physical Therapist	NY
6	207X00000X	Orthopaedic Surgery Physician	NY

General Provider Information

NPI Number	:	1134231566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND MUSCULOSKELETAL CARE, M.D., P.C.

Provider Business Mailing Address
First Line	:	PO BOX 360
Second Line	:
City	:	HEWLETT
State	:	NY
Zip	:	11557-0360
Country	:	US
Telephone Number	:	516-374-6838
Fax Number	:	516-374-2362

Provider Business Practice Location Address
First Line	:	2475 EASTCHESTER RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5915
Country	:	US
Telephone Number	:	718-627-3342
Fax Number	:	516-374-2362

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARRY D JUPITER
Credential	:	MD
Telephone Number	:	516-374-6838

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/14/2012

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