MEDICARE: SOUTH SHORE COMPREHENSIVE MEDICAL GROUP, 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	207RP1001X	Pulmonary Disease Physician	167384	NY

General Provider Information

NPI Number	:	1740272087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SHORE COMPREHENSIVE MEDICAL GROUP, PC

Provider Business Mailing Address
First Line	:	4567 CROSSROADS PARK DR
Second Line	:	2ND FLOOR
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-3589
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W MAIN ST
Second Line	:	SUITE 110
City	:	BABYLON
State	:	NY
Zip	:	11702-3027
Country	:	US
Telephone Number	:	631-669-4500
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	DR. PEDRO H CALVES
Credential	:	M.D.
Telephone Number	:	631-669-4500

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	08/22/2020

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