South Shore Osteopathic Medicine P.C.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

254873 Issued in NY

Legal business name

SOUTH SHORE OSTEOPATHIC MEDICINE P.C.

Practice address

2409 Ocean Ave Unit 1F
Brooklyn, NY 11229-3576

Phone

(718) 444-7774

Fax

(718) 444-7775

NPI assigned

Jul 26, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Yuryev, DONPI 1174857817

Title

President

Phone

(718) 444-7774

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Yuryev, DO

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1174857817
  Medicare reassignment NPD Authorized official
• Inna N Yuryev-Golger, MD

  • Psychiatry Physician
  • Brooklyn, NY
  • NPI 1053324780
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570147200000",
    "number": "1063768174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2409 OCEAN AVE UNIT 1F",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112293576",
            "telephone_number": "718-444-7774",
            "fax_number": "718-444-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2409 OCEAN AVE UNIT 1F",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112293576",
            "telephone_number": "718-444-7774",
            "fax_number": "718-444-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE OSTEOPATHIC MEDICINE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-26",
        "last_updated": "2019-10-04",
        "status": "A",
        "authorized_official_last_name": "YURYEV",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-444-7774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "254873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "A100073001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Brooklyn Pharma Corp
• South Brooklyn Psychological Services PLLC
• South Brooklyn Radiology PLLC
• South Elliot South Portland Medical Comprehensive Medical Center
• South Shore Manor Home for Adults
• South Side Drugs Inc
• South Side Pharmacy & Health Shop LLC
• South Side Pharmacy & Health Shop LLC
• Suzan South-Hylton, LPN
• Austin South

• Primary Care Clinic/Center in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.