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General NPI Number Information
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NPI Number | 1184034092
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Entity Type | Organization
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Legal Business Name | ASSURE SURGICAL PC
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 19 IRVING PL
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City | WOODMERE
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State | NY
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Zip | 11598-1229
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Country | US
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Telephone | 516-295-0404
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Fax | 516-368-3768
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Provider Business Mailing Address
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Address Line | 19 IRVING PL
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City | WOODMERE
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State | NY
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Zip | 11598-1229
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Country | US
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Telephone | 516-295-0404
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Fax | 516-368-3768
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID K. FUNT
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Credential | M.D.
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Telephone | 516-295-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CERT # 1855
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License Number State | NY
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