Healthcare Provider Details

I. General information

NPI: 1003131947
Provider Name (Legal Business Name): SOUNDVIEW MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NORTHERN BLVD SUITE 175
GREAT NECK NY
11021-5312
US

IV. Provider business mailing address

1000 NORTHERN BLVD SUITE 175
GREAT NECK NY
11021-5312
US

V. Phone/Fax

Practice location:
  • Phone: 516-439-5223
  • Fax:
Mailing address:
  • Phone: 516-439-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number179574
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number179574
License Number StateNY

VIII. Authorized Official

Name: DR. PERRY STEVENS
Title or Position: PRESIDENT
Credential: MD
Phone: 516-439-5223