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General NPI Number Information
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NPI Number | 1144199506
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Entity Type | Individual
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Provider Name | SUMAITA SADIDA BUSHRA MD
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Gender | Female
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 141 DOSORIS LN
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City | GLEN COVE
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State | NY
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Zip | 11542-1225
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Country | US
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Telephone | 516-676-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 366 W 23RD ST
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City | DEER PARK
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State | NY
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Zip | 11729-6331
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Country | US
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Telephone | 480-797-1771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P139035
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License Number State | NY
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