Organization
EAST END PHYSICIAN SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LLOYD DOUGLAS SIMON MD (PRESIDENT (CORPORATION))
(631) 765-4150
Entity
Organization
Contact information
Practice address
44210 COUNTY RD. 48, SOUTHOLD, NY 11971
(631) 765-4150
(631) 765-4688
Mailing address
P.O. BOX 1341, SOUTHOLD, NY 11971
(631) 765-4150
(631) 765-4688
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
153210-1
NY
207RA0401X
Addiction Medicine (Internal Medicine) Physician
153210-1
NY
Other
Enumeration date
12/04/2012
Last updated
06/14/2017
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