Provider Demographics
NPI:1689883068
Name:SOUND SHORE PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:SOUND SHORE PHYSICIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:LANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-365-3353
Mailing Address - Street 1:16 GUION PL
Mailing Address - Street 2:ISELIN HALL, ROOM 107
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5503
Mailing Address - Country:US
Mailing Address - Phone:914-365-3353
Mailing Address - Fax:
Practice Address - Street 1:16 GUION PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5503
Practice Address - Country:US
Practice Address - Phone:914-365-3160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUND SHORE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03096297Medicaid
NYW66241Medicare PIN