Healthcare Provider Details

I. General information

NPI: 1871634253
Provider Name (Legal Business Name): SPS MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 HEMPSTEAD TPKE SUIITE 19
BETHPAGE NY
11714
US

IV. Provider business mailing address

141 MELANIE DR
EAST MEADOW NY
11554-1436
US

V. Phone/Fax

Practice location:
  • Phone: 516-735-5522
  • Fax: 516-644-5385
Mailing address:
  • Phone: 516-735-5522
  • Fax: 516-644-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number210715
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number202133
License Number StateNY

VIII. Authorized Official

Name: DR. PREM L SAGAR
Title or Position: OWNER
Credential: M.D.
Phone: 516-735-5522