Healthcare Provider Details

I. General information

NPI: 1003710088
Provider Name (Legal Business Name): EMAN SOULTAN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 FOREST AVE
STATEN ISLAND NY
10310-2408
US

IV. Provider business mailing address

34 OCEAN CT
STATEN ISLAND NY
10301-4563
US

V. Phone/Fax

Practice location:
  • Phone: 718-759-1999
  • Fax:
Mailing address:
  • Phone: 718-759-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MELODY SALVADOR
Title or Position: BILLER
Credential:
Phone: 917-495-6702