Healthcare Provider Details

I. General information

NPI: 1174501431
Provider Name (Legal Business Name): MAGDI SADEK SOUROUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/24/2021
Certification Date: 01/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NORTH VILLAGE AVENUE SUITE 208
ROCKVILLE CENTER NY
11570
US

IV. Provider business mailing address

2000 NORTH VILLAGE AVENUE SUITE 208
ROCKVILLE CENTER NY
11570
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-1466
  • Fax: 516-766-7655
Mailing address:
  • Phone: 516-766-1466
  • Fax: 516-766-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number163533
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number163533
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number163533
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: