| South Shore Medical Care, Pc | |
|
16 Van Cott Rd Suite 2e Deer Park NY 11729-6519 | |
| (631) 274-0777 | |
| (631) 274-9499 |
| Full Name | South Shore Medical Care, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 16 Van Cott Rd, Deer Park, New York |
| Authorized Official Name and Position | Marc Albert Lewandoski (DOCTOR) |
| Authorized Official Contact | 6312740777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Shore Medical Care, Pc 16 Van Cott Rd Suite 2e Deer Park NY 11729-6519 Ph: (631) 274-0777 | South Shore Medical Care, Pc 16 Van Cott Rd Suite 2e Deer Park NY 11729-6519 Ph: (631) 274-0777 |
| NPI Number | 1861696171 |
|---|---|
| Provider Enumeration Date | 06/12/2007 |
| Last Update Date | 01/10/2012 |
| Medicare PECOS PAC ID | 5799727780 |
|---|---|
| Medicare Enrollment ID | O20050601000033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861696171 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 21762 (New York) | Primary |
| Provider Name | Marc A. Lewandoski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982676334 PECOS PAC ID: 4183690704 Enrollment ID: I20040906000031 |
| Provider Name | Robert E Gribbin |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477880771 PECOS PAC ID: 1254455421 Enrollment ID: I20100825000886 |
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