# SOUTH SHORE BAY SHORE MEDICAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134848070
- **Authorized official:** HEATHER OCHOA (MANAGER)
- **Authorized official phone:** (631) 833-3026

## Contact information

- **Practice address:** 24 BRENTWOOD RD \# D, BAY SHORE, NY 11706-8011
- **Practice address phone:** (631) 647-4567
- **Practice address fax:** (631) 647-4568
- **Mailing address:** 24 BRENTWOOD RD \# D, BAY SHORE, NY 11706-8011
- **Mailing address phone:** (631) 647-4567
- **Mailing address fax:** (631) 647-4568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/24/2022
- **Last updated:** 10/25/2023