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General NPI Number Information
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NPI Number | 1114519238
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Entity Type | Organization
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Legal Business Name | SUNRISE MED PLUS LLC
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 737 COMMACK RD
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City | BRENTWOOD
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State | NY
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Zip | 11717-7407
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 737 COMMACK RD
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City | BRENTWOOD
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State | NY
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Zip | 11717-7407
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Country | US
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Telephone | 631-388-7500
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Fax | 631-859-1100
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Authorized Official
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Title or Position | CREDENTIALING
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Name | HECTOR MELGAR
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Credential |
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Telephone | 631-790-9436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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