Healthcare Provider Details

I. General information

NPI: 1679698310
Provider Name (Legal Business Name): STATEN ISLAND ORTHOPEDICS & SPORTS MEDICINE P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 RICHMOND ROAD
STATEN ISLAND NY
10306
US

IV. Provider business mailing address

2052 RICHMOND ROA
STATEN ISLAND NY
10306
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-6500
  • Fax: 718-351-7672
Mailing address:
  • Phone: 718-351-6500
  • Fax: 718-351-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. MARK F SHERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-351-6500