South Shore Faculty Medical Affiliates, University Faculty Practice Co

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

SOUTH SHORE FACULTY MEDICAL AFFILIATES, UNIVERSITY FACULTY PRACTICE CO

Practice address

301 E Main St
Bay Shore, NY 11706-8408

Phone

(631) 968-3000

Fax

(631) 968-3315

NPI assigned

Jul 8, 2024

Organization subpart

No

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

Authorized official

Name

Victoria A Gangale, PA

Title

Physician Assistant

Phone

(631) 968-3000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1720824840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068408",
            "telephone_number": "631-968-3000",
            "fax_number": "631-968-3315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068408",
            "telephone_number": "631-968-3000",
            "fax_number": "631-968-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE FACULTY MEDICAL AFFILIATES, UNIVERSITY FACULTY PRACTICE CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "GANGALE",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "631-968-3000",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosa Soto
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• South Shore Psychiatric Nurse Practitioner Group
• South Shore SC, LLC
• South Shore Surgical Consulting PC
• South Shore University Hospital

• Physician Assistant in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.