Provider Demographics
NPI:1891998373
Name:OAKDALE MEDICAL SERVICES
Entity Type:Organization
Organization Name:OAKDALE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:B
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-968-3000
Mailing Address - Street 1:971 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1434
Mailing Address - Country:US
Mailing Address - Phone:631-675-4149
Mailing Address - Fax:
Practice Address - Street 1:971 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1434
Practice Address - Country:US
Practice Address - Phone:631-675-4149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHSIDE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-11
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW8G551Medicare PIN