Healthcare Provider Details

I. General information

NPI: 1558671867
Provider Name (Legal Business Name): S & A CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 02/16/2011
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 Code173000000X
TaxonomyLegal Medicine
License Number151853
License Number StateNY

VIII. Authorized Official

Name: DR. MICHEL ANTOINE
Title or Position: OWNER
Credential: M.D.
Phone: 845-356-3500