Healthcare Provider Details

I. General information

NPI: 1942290994
Provider Name (Legal Business Name): DAVID SISKIND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BEACH DR
WEST ISLIP NY
11795-4929
US

IV. Provider business mailing address

1 SALEM CT
SYOSSET NY
11791-2914
US

V. Phone/Fax

Practice location:
  • Phone: 631-587-1600
  • Fax:
Mailing address:
  • Phone: 516-521-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number187771
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: