Healthcare Provider Details

I. General information

NPI: 1508274853
Provider Name (Legal Business Name): 758 MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 56TH ST
BROOKLYN NY
11220-3504
US

IV. Provider business mailing address

758 56TH ST
BROOKLYN NY
11220-3504
US

V. Phone/Fax

Practice location:
  • Phone: 718-436-3023
  • Fax:
Mailing address:
  • Phone: 718-436-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SEONGPAN SI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-436-3023