# SOUTH SHORE FAMILY MEDICINE,PC

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

## Provider details

- **NPI number:** 1932420817
- **Authorized official:** MARIE MARINO (BILLING MANAGER)
- **Authorized official phone:** (516) 623-9675

## Contact information

- **Practice address:** 2280 GRAND AVE, SUITE 208, BALDWIN, NY 11510-3164
- **Practice address phone:** (516) 623-4800
- **Practice address fax:** (516) 623-8845
- **Mailing address:** 2280 GRAND AVE, SUITE 208, BALDWIN, NY 11510-3164
- **Mailing address phone:** (516) 623-4800
- **Mailing address fax:** (516) 623-8845

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/15/2010
- **Last updated:** 06/15/2010