Provider Demographics
NPI:1306954292
Name:SOUTH ISLAND FAMILY MEDICAL, LLC
Entity type:Organization
Organization Name:SOUTH ISLAND FAMILY MEDICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-670-8800
Mailing Address - Street 1:4042-A AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1226
Mailing Address - Country:US
Mailing Address - Phone:516-670-8800
Mailing Address - Fax:516-670-8803
Practice Address - Street 1:4042A AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1226
Practice Address - Country:US
Practice Address - Phone:516-670-8800
Practice Address - Fax:516-670-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY896161Medicare ID - Type UnspecifiedPROVIDER ID
NY11V561Medicare ID - Type UnspecifiedPROVIDER ID