Healthcare Provider Details

I. General information

NPI: 1174223515
Provider Name (Legal Business Name): MINIMALLY INVASIVE CENTER OF NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 06/21/2024
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 COMMACK RD STE 103
COMMACK NY
11725-3405
US

IV. Provider business mailing address

100 MOTOR PKWY STE LL8
HAUPPAUGE NY
11788-5165
US

V. Phone/Fax

Practice location:
  • Phone: 833-547-7463
  • Fax: 631-248-5583
Mailing address:
  • Phone: 833-547-7463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIT SHARMA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 917-400-6184