Healthcare Provider Details

I. General information

NPI: 1083931612
Provider Name (Legal Business Name): PULMONARY CRITICAL CARE & SLEEP MEDICINE OF NASSAU P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250-12 HILLSIDE AVENUE SUITE B
BELLEROSE NY
11426-2139
US

IV. Provider business mailing address

65-11 BOOTH STREET SUITE 1C
REGO PARK NY
11374-4184
US

V. Phone/Fax

Practice location:
  • Phone: 718-347-0411
  • Fax: 718-347-0455
Mailing address:
  • Phone: 718-806-1434
  • Fax: 718-806-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number241650
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number241650
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number241650
License Number StateNY

VIII. Authorized Official

Name: MR. SANDEEP MEHRISHI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-347-0411