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General NPI Number Information
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NPI Number | 1265237085
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Entity Type | Organization
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Legal Business Name | SUN MOUNTAIN MEDICAL PLLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 4140 JUNCTION BLVD
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City | CORONA
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State | NY
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Zip | 11368-3584
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Country | US
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Telephone | 917-400-3941
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Fax | 718-447-7831
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Provider Business Mailing Address
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Address Line | 565 JEWETT AVE BSMT MEDICAL
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City | STATEN ISLAND
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State | NY
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Zip | 10302-2654
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Country | US
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Telephone | 917-400-3941
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Fax | 718-447-7831
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAILESH S PATHARE
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Credential | MD
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Telephone | 917-400-3941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive 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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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