Main Street Medical, Pc | |
38-40 East Main Street Bay Shore NY 11706 | |
(631) 647-9555 | |
(631) 647-9548 |
Full Name | Main Street Medical, Pc |
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Speciality | Internal Medicine |
Location | 38-40 East Main Street, Bay Shore, New York |
Authorized Official Name and Position | Kalman Ausubel (OWNER) |
Authorized Official Contact | 6316479555 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Main Street Medical, Pc 38-40 East Main Street Bay Shore NY 11706 Ph: (631) 647-9555 | Main Street Medical, Pc 38-40 East Main Street Bay Shore NY 11706 Ph: (631) 647-9555 |
NPI Number | 1184049835 |
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Provider Enumeration Date | 03/04/2014 |
Last Update Date | 03/04/2014 |
Medicare PECOS PAC ID | 4880971605 |
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Medicare Enrollment ID | O20170504001433 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184049835 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
207RC0000X | Internal Medicine - Cardiovascular Disease | (* (Not Available)) | Secondary |
Provider Name | Roy Shanon |
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Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1285723791 PECOS PAC ID: 3173799566 Enrollment ID: I20120106000303 |
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