Healthcare Provider Details

I. General information

NPI: 1225050412
Provider Name (Legal Business Name): SHELDON BRUCE PIKE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 BROADWAY
HEWLETT NY
11557-2323
US

IV. Provider business mailing address

1500 ROUTE 112 STE 101
PORT JEFFERSON STATION NY
11776-8054
US

V. Phone/Fax

Practice location:
  • Phone: 516-239-8877
  • Fax: 516-239-1104
Mailing address:
  • Phone: 631-751-3000
  • Fax: 631-751-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number168657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: