Organization
SOUTH OCEAN CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A RAIFMAN MD (MANAGING MEMBER)
(516) 623-3600
Entity
Organization
Contact information
Practice address
101 S BERGEN PL, FREEPORT, NY 11520-3528
(516) 623-3600
(516) 623-9191
Mailing address
PO BOX 624, WOODMERE, NY 11598-0624
(516) 623-3600
(516) 623-9191
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2904201R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02289783
—
NY
Enumeration date
12/14/2005
Last updated
05/21/2008
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