Provider Demographics
NPI:1386856334
Name:SOUTH SHORE FAMILY PRACTICE, D.O., P.C.
Entity Type:Organization
Organization Name:SOUTH SHORE FAMILY PRACTICE, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GOLINOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-795-8446
Mailing Address - Street 1:616 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5024
Mailing Address - Country:US
Mailing Address - Phone:516-795-8446
Mailing Address - Fax:516-795-2981
Practice Address - Street 1:5440 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6213
Practice Address - Country:US
Practice Address - Phone:516-795-8446
Practice Address - Fax:516-795-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty