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NPI Code Detail

MEDICARE: BEACH & SURF MEDICAL, PC

MEDICARE: BEACH & SURF MEDICAL, 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
1207Q00000XFamily Medicine Physician211117NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821183823
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACH & SURF MEDICAL, PC
Provider Business Mailing Address
First Line : 1011 W BEECH ST
Second Line :
City : LONG BEACH
State : NY
Zip : 11561-1203
Country : US
Telephone Number : 516-431-7600
Fax Number : 516-431-7691
Provider Business Practice Location Address
First Line : 1011 W BEECH ST
Second Line :
City : LONG BEACH
State : NY
Zip : 11561-1203
Country : US
Telephone Number : 516-431-7600
Fax Number : 516-431-7691
Authorized Official
Title or Position : PHYSICIAN/OWNER
Name : EDWARD M KLEINER
Credential : D.O.
Telephone Number : 516-431-7600
Provider Enumeration Date : 10/04/2006
Last Update Date : 02/05/2015

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Directions to “BEACH & SURF MEDICAL, PC ” Practice Location

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