Healthcare Provider Details

I. General information

NPI: 1922303387
Provider Name (Legal Business Name): SAND DOLLAR HEALTH MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 FLATBUSH AVE
BROOKLYN NY
11210-3943
US

IV. Provider business mailing address

1706 FLATBUSH AVE
BROOKLYN NY
11210-3943
US

V. Phone/Fax

Practice location:
  • Phone: 718-951-0484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0016092
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1033449319
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2187382
License Number StateNY

VIII. Authorized Official

Name: REGINALD HUGHES
Title or Position: PRESIDENT
Credential:
Phone: 718-951-0484