Healthcare Provider Details

I. General information

NPI: 1336791870
Provider Name (Legal Business Name): SYDNEY ASSELSTINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYDNEY ASSELSTINE-SMITH

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07305-2106
US

IV. Provider business mailing address

1825 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07305-2106
US

V. Phone/Fax

Practice location:
  • Phone: 201-942-4545
  • Fax:
Mailing address:
  • Phone: 201-942-4545
  • Fax: 201-918-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MA11524800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: