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General NPI Number Information
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NPI Number | 1225689532
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Entity Type | Organization
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Legal Business Name | SYLVAN STREET MEDICAL, P.C.
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Dates
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Enumeration Date | 09/27/2019
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 450 LEXINGTON AVE FL 4
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City | NEW YORK
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State | NY
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Zip | 10017-3912
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Country | US
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Telephone | 888-885-2336
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Fax |
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Provider Business Mailing Address
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Address Line | 450 LEXINGTON AVE FL 4
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City | NEW YORK
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State | NY
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Zip | 10017-9998
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Country | US
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Telephone | 888-885-2336
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL DELGIUDICE
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Credential | MD
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Telephone | 603-533-1873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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