Healthcare Provider Details

I. General information

NPI: 1336860733
Provider Name (Legal Business Name): SG MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W 39TH ST FL 8
NEW YORK NY
10018-4073
US

IV. Provider business mailing address

25 W 39TH ST FL 8
NEW YORK NY
10018-4073
US

V. Phone/Fax

Practice location:
  • Phone: 917-565-8540
  • Fax:
Mailing address:
  • Phone: 917-565-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY MULCARE
Title or Position: PRESIDENT
Credential: MD
Phone: 203-912-0283