Provider Demographics
NPI:1023102696
Name:BAY SHORE FAMILY MEDICINE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:BAY SHORE FAMILY MEDICINE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-665-8515
Mailing Address - Street 1:19 EAST MAIN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-665-0760
Mailing Address - Fax:631-665-1886
Practice Address - Street 1:19 EAST MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-0760
Practice Address - Fax:631-665-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162359207Q00000X
NY221368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4C8783OtherHEALTHNET
NY3504180OtherCIGNA
NYP2695103OtherOXFORD
NY2C7645OtherHEALTHNET
NY8C9721OtherB/CB/S
NY1172OtherVYTRA
NY5997110OtherGHI
NYCP461OtherOXFORD
NY0012303OtherGHI
NY15E111OtherB/CB/S
NY162359-A30OtherAHEALTH FIRST
NY332368-A30OtherHEALTH FIRST
NY6009146OtherCIGNA
NYA60769Medicare UPIN
NY0012303OtherGHI
NY332368-A30OtherHEALTH FIRST