South Shore Family Medical Associates, P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

205232 Issued in NY

Legal business name

SOUTH SHORE FAMILY MEDICAL ASSOCIATES, P.C.

Practice address

271 Doughty Blvd
Inwood, NY 11096-2135

Phone

(516) 371-6884

Fax

(516) 371-6083

NPI assigned

Feb 16, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Allan Scott Detweiler, D.O.NPI 1992706402

Title

President

Phone

(516) 371-6884

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Allan Scott Detweiler, D.O.

  • Family Medicine Physician
  • Inwood, NY
  • NPI 1992706402
  Medicare reassignment Care Compare group NPD Authorized official
• John Douglas Bedell III, DO

  • Family Medicine Physician
  • Island Park, NY
  • NPI 1528254570
  Medicare reassignment Care Compare group NPD
• Sther Charlot, MSN, FNP

  • Family Nurse Practitioner
  • Amityville, NY
  • NPI 1104712645
  Medicare reassignment Care Compare group NPD
• Rayven Mason, FNP

  • Family Nurse Practitioner
  • Inwood, NY
  • NPI 1134908114
  Medicare reassignment Care Compare group NPD
• M Joseph Vitoulis, DO

  • Family Medicine Physician
  • Lynbrook, NY
  • NPI 1154402030
  Medicare reassignment Care Compare group NPD
• Olivia Agnes McColgan, PA-C

  • Physician Assistant
  • Long Beach, NY
  • NPI 1619714847
  Medicare reassignment Care Compare group
• Arielle Cara T. Agbaje, FNP

  • Family Nurse Practitioner
  • New York, NY
  • NPI 1154813111
  Medicare reassignment NPD
• Natalya Ageyeva, NP

  • Adult Health Nurse Practitioner
  • New York, NY
  • NPI 1982863072
  Medicare reassignment NPD
• Michael Britton, FNP-BC

  • Family Nurse Practitioner
  • Harris, NY
  • NPI 1255970901
  Medicare reassignment NPD
• Laquana Melissa Brown, NP

  • Family Nurse Practitioner
  • Rego Park, NY
  • NPI 1528815131
  Medicare reassignment NPD
• Ketsia Desrosiers, FNP-BC

  • Family Nurse Practitioner
  • Airmont, NY
  • NPI 1942787320
  Medicare reassignment NPD
• Dian Dyer, FNP

  • Family Nurse Practitioner
  • Baldwin, NY
  • NPI 1396328936

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720122716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 DOUGHTY BLVD",
            "city": "INWOOD",
            "state": "NY",
            "postal_code": "110962135",
            "telephone_number": "516-371-6884",
            "fax_number": "516-371-6083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 DOUGHTY BLVD",
            "city": "INWOOD",
            "state": "NY",
            "postal_code": "110962135",
            "telephone_number": "516-371-6884",
            "fax_number": "516-371-6083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE FAMILY MEDICAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DETWEILER",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-371-6884",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "205232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather A Smith, RBT
• Janet C Smith
• Jenny E Smith
• Harshini Devi Sobhan, PHARMD
• Sharon Rae Solomon-Fried Cander, LCSW-R
• Shira D Spira
• Marcie Evans Stein, O.D.
• Daniel Tagliavia, RPH
• Colleen Mary Tanaka, M.S. ED
• Anacecilia Toribio

• Family Medicine Physician in Inwood, NY
• Providers in Inwood, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.