Provider Demographics
NPI:1093745333
Name:SOUTH SHORE PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:SOUTH SHORE PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAZZARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-966-3700
Mailing Address - Street 1:3589 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3513
Mailing Address - Country:US
Mailing Address - Phone:718-966-3700
Mailing Address - Fax:
Practice Address - Street 1:3589 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3513
Practice Address - Country:US
Practice Address - Phone:718-966-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty