# SOUTH SHORE SC, LLC

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

## Provider details

- **NPI number:** 1508005976
- **Authorized official:** WENDY NIL MARTINEZ RN (FACILITY ADMINISTRATOR)
- **Authorized official phone:** (631) 647-5550

## Contact information

- **Practice address:** 53 BRENTWOOD RD, BAY SHORE, NY 11706-6923
- **Practice address phone:** (781) 733-2235
- **Practice address fax:** (973) 506-1887
- **Mailing address:** 53 BRENTWOOD RD STE F, BAY SHORE, NY 11706-6943
- **Mailing address phone:** (631) 647-5550
- **Mailing address fax:** (631) 647-5549

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/09/2009
- **Last updated:** 11/16/2023