Basic Information
| Provider Information | |||||||||
| NPI: | 1730670787 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKY BLUE HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 SUITS AVE | ||||||||
| Address2: | |||||||||
| City: | HOMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130779416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075915349 | ||||||||
| FaxNumber: | 6074285077 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 SUITS AVE | ||||||||
| Address2: | |||||||||
| City: | HOMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130779416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075915349 | ||||||||
| FaxNumber: | 6074285077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2018 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | DARSHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6075915349 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 250558 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.