Healthcare Provider Details

I. General information

NPI: 1093076606
Provider Name (Legal Business Name): SYOSSET ENDOCRINOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 JERICHO TPKE SUITE 204
SYOSSET NY
11791-4532
US

IV. Provider business mailing address

175 JERICHO TPKE STE 201
SYOSSET NY
11791-4538
US

V. Phone/Fax

Practice location:
  • Phone: 631-271-9151
  • Fax:
Mailing address:
  • Phone: 631-271-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number239938
License Number StateNY

VIII. Authorized Official

Name: ALLA KHALFIN
Title or Position: OWNER
Credential: M.D.
Phone: 631-271-9151