Provider Demographics
NPI:1588824981
Name:GREAT SOUTH BAY FAMILY MEDICAL PRACTICE LLP
Entity Type:Organization
Organization Name:GREAT SOUTH BAY FAMILY MEDICAL PRACTICE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-563-6205
Mailing Address - Street 1:213 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11796-1800
Mailing Address - Country:US
Mailing Address - Phone:631-563-6205
Mailing Address - Fax:631-563-7718
Practice Address - Street 1:213 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11796-1800
Practice Address - Country:US
Practice Address - Phone:631-563-6205
Practice Address - Fax:631-563-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty