Healthcare Provider Details

I. General information

NPI: 1629495601
Provider Name (Legal Business Name): SUNRISE MEDICAL PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1975 HYLAN BLVD
STATEN ISLAND NY
10306-3526
US

IV. Provider business mailing address

1975 HYLAN BLVD
STATEN ISLAND NY
10306-3523
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-5400
  • Fax: 718-351-6848
Mailing address:
  • Phone: 718-667-5400
  • Fax: 718-351-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number257063
License Number StateNY

VIII. Authorized Official

Name: STEVEN SCHIEBERT
Title or Position: PRESIDENT
Credential: DO
Phone: 718-667-5400