Healthcare Provider Details

I. General information

NPI: 1720663768
Provider Name (Legal Business Name): NEW YORK SURGICALIST SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 GIDNEY AVE
NEWBURGH NY
12550-3117
US

IV. Provider business mailing address

PO BOX 208972
DALLAS TX
75320-0001
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-0400
  • Fax:
Mailing address:
  • Phone: 916-441-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN M. REED
Title or Position: DIRECTOR OF LEGAL AFFAIRS
Credential:
Phone: 916-441-0400