Provider Demographics
NPI:1164087375
Name:SOUTH SHORE MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:SOUTH SHORE MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-422-5371
Mailing Address - Street 1:1175 MONTAUK KWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-422-5371
Mailing Address - Fax:631-893-8012
Practice Address - Street 1:1175 MONTAUK KWY
Practice Address - Street 2:SUITE 6
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-422-5371
Practice Address - Fax:631-893-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty