Organization
SOUTH SHORE OSTEOPATHIC MEDICINE P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL YURYEV DO (PRESIDENT)
(718) 444-7774
Entity
Organization
Contact information
Practice address
2409 OCEAN AVE UNIT 1F, BROOKLYN, NY 11229-3576
(718) 444-7774
(718) 444-7775
Mailing address
2409 OCEAN AVE UNIT 1F, BROOKLYN, NY 11229-3576
(718) 444-7774
(718) 444-7775
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
254873
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A100073001
MEDICARE PTAN
NY
Enumeration date
07/26/2012
Last updated
10/04/2019
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