# SOUTH SHORE ROCKAWAYS IPA

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

## Provider details

- **NPI number:** 1659824225
- **Authorized official:** DR. GILBERT G MAKABALI MD (CEO)
- **Authorized official phone:** (516) 823-8900

## Contact information

- **Practice address:** 600 BROADWAY UNIT B, LYNBROOK, NY 11563-3980
- **Practice address phone:** (516) 823-8900
- **Practice address fax:** (516) 823-0520
- **Mailing address:** 600 BROADWAY UNIT B, LYNBROOK, NY 11563-3980
- **Mailing address phone:** (516) 823-8900
- **Mailing address fax:** (516) 823-8900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 07/29/2016
- **Last updated:** 07/29/2016