Organization
MEDICAL SERVICES OF KIPS BAY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE L CUSACK (SENIOR VICE PRESIDENT & CFO)
(516) 321-6058
Entity
Organization
Contact information
Practice address
170 GREAT NECK RD, GREAT NECK, NY 11021-3357
(516) 487-4464
(516) 487-4980
Mailing address
325 E MAIN ST, PATCHOGUE, NY 11772-3114
(516) 358-8100
(631) 654-1474
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
2084N0400X
Neurology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
11/20/2020
Last updated
10/06/2022
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