| South Island Medical Care Pc | |
|
76 Southaven Ave Suite 5 Medford NY 11763-3745 | |
| (631) 447-8860 | |
| (631) 447-8862 |
| Full Name | South Island Medical Care Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 76 Southaven Ave, Medford, New York |
| Authorized Official Name and Position | M Hani Salam (PRESIDENT/ SOLO PRACTICE) |
| Authorized Official Contact | 6314478860 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Island Medical Care Pc 76 Southaven Ave Suite 5 Medford NY 11763-3745 Ph: (631) 447-8860 | South Island Medical Care Pc 76 Southaven Ave Suite 5 Medford NY 11763-3745 Ph: (631) 447-8860 |
| NPI Number | 1306841911 |
|---|---|
| Provider Enumeration Date | 06/20/2005 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5294625661 |
|---|---|
| Medicare Enrollment ID | O20040318000854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306841911 | NPI | - | NPPES |
| 5081A1 | Other | NY | EMPIRE BC/BS |
| 9569338 | Other | NY | CIGNA |
| 01770227 | Medicaid | NY | |
| 640938 | Other | NY | HEALTHCARE PARTNERS IPA |
| 7082351 | Other | NY | AETNA |
| P2666424 | Other | NY | OXFORD |
| 115904 | Other | NY | VYTRA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 207811 (New York) | Primary |
| Provider Name | M Hani Salam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427067644 PECOS PAC ID: 4284626094 Enrollment ID: I20040401000471 |
| Provider Name | Maureen F Nofi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083868004 PECOS PAC ID: 2365694072 Enrollment ID: I20121204000032 |
| Provider Name | Lisa Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487216743 PECOS PAC ID: 3779814306 Enrollment ID: I20191014001632 |
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