Provider Demographics
NPI:1588850358
Name:THE SOUTH SHORE WELLNESS CENTER CORP
Entity Type:Organization
Organization Name:THE SOUTH SHORE WELLNESS CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PALERMO
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:631-581-6900
Mailing Address - Street 1:2915 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2716
Mailing Address - Country:US
Mailing Address - Phone:631-581-6900
Mailing Address - Fax:631-581-6910
Practice Address - Street 1:2915 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2716
Practice Address - Country:US
Practice Address - Phone:631-581-6900
Practice Address - Fax:631-581-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy