# SOUTH SHORE MEDICAL CARE &DIAGNOSTIC, PC

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

## Provider details

- **NPI number:** 1700054954
- **Authorized official:** DR. ANDREA S COLADNER DO (PRESIDENT)
- **Authorized official phone:** (631) 737-5143

## Contact information

- **Practice address:** 4250 VETERANS MEMORIAL HWY, SUITE 1020, HOLBROOK, NY 11741-4000
- **Practice address phone:** (631) 737-5143
- **Practice address fax:** (631) 737-5224
- **Mailing address:** 4250 VETERANS MEMORIAL HWY, SUITE 1020, HOLBROOK, NY 11741-4000
- **Mailing address phone:** (631) 737-5143
- **Mailing address fax:** (631) 737-5224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | C09215 | NY | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 1867861 | NY | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | 2192491 | NY | — |

## Other

- **Enumeration date:** 02/11/2008
- **Last updated:** 02/11/2008