Healthcare Provider Details

I. General information

NPI: 1891095808
Provider Name (Legal Business Name): SILVER MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E 14TH ST
BROOKLYN NY
11229-1104
US

IV. Provider business mailing address

PO BOX 340158
BROOKLYN NY
11234-0158
US

V. Phone/Fax

Practice location:
  • Phone: 347-417-9081
  • Fax: 718-732-2434
Mailing address:
  • Phone: 347-417-9081
  • Fax: 718-732-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA SHORE
Title or Position: ADMINISTRATOR
Credential:
Phone: 347-417-9081