Organization
SOUTHSHORE MEDICAL PRACTICE MANAGEMENT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA PACAUD BREZAULT (ADMINISTRATOR)
(631) 604-4020
Entity
Organization
Contact information
Practice address
56 W MAIN ST STE 203, BAY SHORE, NY 11706-8327
(631) 604-4020
Mailing address
56 W MAIN ST STE 203, BAY SHORE, NY 11706-8327
(631) 604-4020
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/13/2011
Last updated
01/24/2011
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