Healthcare Provider Details

I. General information

NPI: 1255305900
Provider Name (Legal Business Name): SOUTHERN WESTCHESTER DIABETES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 W 238TH ST # A
BRONX NY
10463-2423
US

IV. Provider business mailing address

226 W 238TH ST # A
BRONX NY
10463-2423
US

V. Phone/Fax

Practice location:
  • Phone: 718-601-3300
  • Fax:
Mailing address:
  • Phone: 718-601-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number195964
License Number StateNY

VIII. Authorized Official

Name: DR. NADEM JAMIL SAYEGH
Title or Position: OWNER
Credential: M.D.
Phone: 718-601-3300