Healthcare Provider Details

I. General information

NPI: 1134997620
Provider Name (Legal Business Name): SK SPINE SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 E 71ST ST
NEW YORK NY
10021-4871
US

IV. Provider business mailing address

PO BOX 12243
HAUPPAUGE NY
11788-0868
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1039
  • Fax: 917-260-3967
Mailing address:
  • Phone: 212-606-1039
  • Fax: 917-260-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: SARIAH KHORMAEE
Title or Position: OWNER/PHYSICIAN
Credential: MD, PHD
Phone: 212-606-1039