Organization
MEDICAL SERVICES OF KIPS BAY PC
Active
Organization
MEDICAL SERVICES OF KIPS BAY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE L CUSACK (SENIOR VICE PRESIDENT & CFO)
(516) 321-6058
Entity
Organization
Contact information
Practice address
410 LAKEVILLE RD STE 303, NEW HYDE PARK, NY 11042-1104
(516) 321-7555
(516) 321-7831
Mailing address
2000 MARCUS AVE, NEW HYDE PARK, NY 11042-1069
(516) 321-7555
(516) 321-7831
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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