Basic Information
| Provider Information | |||||||||
| NPI: | 1992748248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SINAI NORTH SHORE MEDICAL ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6902 AUSTIN ST | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187936800 | ||||||||
| FaxNumber: | 3473924179 | ||||||||
| Practice Location | |||||||||
| Address1: | 287 NORTHERN BOULEVARD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110214717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164820500 | ||||||||
| FaxNumber: | 5164665565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 12/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | GOLYAN | ||||||||
| AuthorizedOfficialFirstName: | BIJAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7187936800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.