Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southside Hospital Faculty Practice

Organization Family Medicine Physician · NPI 1619934544

Southside Hospital Faculty Practice is a Family Medicine Physician in Bay Shore, New York. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
6

Practice location Address checks out

301 E Main St
Bay Shore, NY 11706-8408
Phone: (631) 675-4149
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Family Medicine Physician Taxonomy 207Q00000X
Pediatrics Physician Taxonomy 208000000X
Physician Assistant Taxonomy 363A00000X
Adult Health Nurse Practitioner Taxonomy 363LA2200X
Family Nurse Practitioner Taxonomy 363LF0000X

Record details

NPI number1619934544
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationSouthside Hospital
Authorized official Winifred Mack — Cfo · (631) 968-9000
NPI enumeratedApril 26, 2006
Last updated in NPPESAugust 13, 2008
Mailing address301 E Main St, Bay Shore, NY 11706-8408

Other providers in Bay Shore