# SOUTH COAST PHYSICAL MEDICINE PC

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

## Provider details

- **NPI number:** 1881961944
- **Authorized official:** MIGUEL VARGAS MD (PRESIDENT)
- **Authorized official phone:** (631) 979-8508

## Contact information

- **Practice address:** 1799 BRENTWOOD RD, BRENTWOOD, NY 11717-4611
- **Practice address phone:** (631) 979-8508
- **Practice address fax:** (631) 979-0998
- **Mailing address:** 1 EDGEWOOD AVE, SUITE 100, SMITHTOWN, NY 11787-2742
- **Mailing address phone:** (631) 979-8508
- **Mailing address fax:** (631) 979-0998

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 213808-1 | NY | Yes |

## Other

- **Enumeration date:** 11/17/2011
- **Last updated:** 11/18/2011