Basic Information
| Provider Information | |||||||||
| NPI: | 1093810301 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KADAYIFCI | ||||||||
| FirstName: | SEVINC | ||||||||
| MiddleName: | ITIR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 EAST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BAY SHORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319683000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 EAST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BAY SHORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319683000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 07/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 240980 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 240980 | NY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1093810301 | 05 | NY | MEDICAID | 02840848 | 05 | NY | MEDICAID |