Healthcare Provider Details

I. General information

NPI: 1750708749
Provider Name (Legal Business Name): ERIC SIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MEETING HOUSE LANE BLDG 2 SUITE 302
SOUTHAMPTON NY
11968
US

IV. Provider business mailing address

325 MEETING HOUSE LANE BLDG. 2 STE 302
SOUTHAMPTON NY
11968
US

V. Phone/Fax

Practice location:
  • Phone: 631-283-8008
  • Fax: 631-283-8870
Mailing address:
  • Phone: 631-283-8008
  • Fax: 631-283-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number290481
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number290481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: