Healthcare Provider Details

I. General information

NPI: 1891924742
Provider Name (Legal Business Name): PALLIATIVE MEDICINE OF NEW YORK, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SHADY LN
SOUTH SALEM NY
10590-1932
US

IV. Provider business mailing address

26 SHADY LN
SOUTH SALEM NY
10590-1932
US

V. Phone/Fax

Practice location:
  • Phone: 914-533-2290
  • Fax: 718-960-4517
Mailing address:
  • Phone: 914-533-2290
  • Fax: 718-960-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH SACCO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 914-533-2290