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SOUTH SHORE MEDICAL CARE PC NPI 1861696171


NPI Information

NPI: 1861696171
Provider Name: SOUTH SHORE MEDICAL CARE, PC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 33D0994505

Address:
16 VAN COTT RD
SUITE 2E
DEER PARK, NY
ZIP 11729
Phone: (631) 274-0777
Get Directions

SOUTH SHORE MEDICAL CARE, PC is a family medicine in Deer Park, NY. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SOUTH SHORE MEDICAL CARE, PC NPI is 1861696171. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

16 VAN COTT RD
SUITE 2E
DEER PARK, NY
ZIP 11729-519
Phone: (631) 274-0777
Fax: (631) 274-9499

The provider's authorized official is Marc Albert Lewandoski .
The authorized official title is Doctor and has the following contact phone number (631) 274-0777.

The CLIA number assigned to this NPI record is 33D0994505 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/12/2007 and was last updated on 1/10/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine21762NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1WEY021MEDICARE ID-TYPE UNSPECIFIEDNEW YORK
2H27968MEDICARE UPINNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.