Provider Demographics
NPI:1487679346
Name:SOUTH SHORE CARDIOVASCULAR MEDICINE
Entity Type:Organization
Organization Name:SOUTH SHORE CARDIOVASCULAR MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUISI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-264-2424
Mailing Address - Street 1:15 SKIPPER DR
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-5029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2742
Practice Address - Country:US
Practice Address - Phone:631-264-2424
Practice Address - Fax:631-264-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161768-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEL591Medicare ID - Type UnspecifiedCARDIOLOGY