Organization Name: | EAST END PHYSICIAN SERVICES PC |
NPI Number: | 1407191364 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LLOYD DOUGLAS SIMON (PRESIDENT (CORPORATION)) |
Mailing Address: | 44210 County Rd. 48 Southold |
State: | NY US |
Postal Code: | 11971 |
Phone Number: | 6317654150 |
Fax Number: | 6317654688 |
NPI Enumeration Date: | 12/04/2012 |
NPI Last Update Date: | 10/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207RA0401X |
License Number: | 153210-1 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Internal Medicine |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |