Healthcare Provider Details

I. General information

NPI: 1619167277
Provider Name (Legal Business Name): SUNRISE MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 EAST SUNRISE HIGHWAY SUITE 108
VALLEY STREAM NY
11581
US

IV. Provider business mailing address

30 EAST SUNRISE HIGHWAY SUITE 108
VALLEY STREAM NY
11581
US

V. Phone/Fax

Practice location:
  • Phone: 516-791-5804
  • Fax: 516-791-5809
Mailing address:
  • Phone: 516-791-5804
  • Fax: 516-791-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number175418
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number171751
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number582205
License Number StateNY

VIII. Authorized Official

Name: DR. HAROLD K. SIROTA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 516-791-5804