Basic Information
| Provider Information | |||||||||
| NPI: | 1609288596 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNISON MEDICAL P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 605043 | ||||||||
| Address2: | |||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113605043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184285333 | ||||||||
| FaxNumber: | 7184285332 | ||||||||
| Practice Location | |||||||||
| Address1: | 21333 39TH AVE | ||||||||
| Address2: | SUITE 248 | ||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113612091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184285333 | ||||||||
| FaxNumber: | 7184285332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2014 | ||||||||
| LastUpdateDate: | 05/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | SOHN | ||||||||
| AuthorizedOfficialFirstName: | WON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7184285333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy |
No ID Information.