Organization
SOUTH SHORE NEUROLOGIC ASSOCIATES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGELA DERITIS CMM (CERTIFIED MEDICAL MANAGER)
(631) 666-3939
Entity
Organization
Contact information
Practice address
712 MAIN ST, ISLIP, NY 11751-3620
(631) 666-3939
(631) 666-3994
Mailing address
712 MAIN ST, ISLIP, NY 11751-3620
(631) 666-3939
(631) 666-3994
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01259347
—
NY
Enumeration date
05/05/2006
Last updated
11/08/2013
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