Southshore Medical Practice Management, Inc

Primary specialty

ContractorTaxonomy code 171W00000X

Legal business name

SOUTHSHORE MEDICAL PRACTICE MANAGEMENT, INC

Practice address

56 W Main St Ste 203
Bay Shore, NY 11706-8327

Phone

(631) 604-4020

NPI assigned

Jan 13, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Patricia Pacaud Brezault

Title

Administrator

Phone

(631) 604-4020

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1294876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295827200000",
    "number": "1649575242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 W MAIN ST STE 203",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068327",
            "telephone_number": "631-604-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 W MAIN ST STE 203",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068327",
            "telephone_number": "631-604-4020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSHORE MEDICAL PRACTICE MANAGEMENT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-13",
        "last_updated": "2011-01-24",
        "status": "A",
        "authorized_official_last_name": "BREZAULT",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "PACAUD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "631-604-4020",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Shore SC, LLC
• South Shore Surgical Consulting PC
• South Shore University Hospital (Vivo Health Pharmacy at South Shore)
• South Shore University Hospital
• South Shore University Hospital
• Southside Hospital
• Southside Hospital
• Southside Hospital Department of Cardiology
• Southside Hospital Department of Neurology
• Southside Hospital Department of Pathology

• Contractor in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Contractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.