Healthcare Provider Details

I. General information

NPI: 1518952167
Provider Name (Legal Business Name): S & A CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N MAIN ST
SPRING VALLEY NY
10977-4002
US

IV. Provider business mailing address

251 N MAIN ST
SPRING VALLEY NY
10977-4002
US

V. Phone/Fax

Practice location:
  • Phone: 845-356-3500
  • Fax: 845-356-9190
Mailing address:
  • Phone: 845-356-3500
  • Fax: 845-356-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number151853
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01151711
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. MICHEL ANTOINE
Title or Position: PRESIDENT
Credential: MD
Phone: 845-356-3500