Healthcare Provider Details

I. General information

NPI: 1790818573
Provider Name (Legal Business Name): PROFESSIONAL EVALUATION MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W 36TH ST FL 10
NEW YORK NY
10018-8949
US

IV. Provider business mailing address

380 S BROADWAY
HICKSVILLE NY
11801-5033
US

V. Phone/Fax

Practice location:
  • Phone: 212-463-8605
  • Fax: 212-463-8579
Mailing address:
  • Phone: 516-935-4378
  • Fax: 516-931-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number147150
License Number StateNY

VIII. Authorized Official

Name: MR. JAMES MICHAEL SHEEHY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 516-935-1730