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General NPI Number Information
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NPI Number | 1326275777
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Entity Type | Organization
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Legal Business Name | MAHENDRA SHARMA MD PC
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 15 KNOLLS DRIVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1110
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Country | US
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Telephone | 516-625-1014
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Fax | 516-414-4012
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Provider Business Mailing Address
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Address Line | 112 MADISON AVE
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City | GARDEN CITY PARK
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State | NY
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Zip | 11040-5229
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Country | US
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Telephone | 516-625-1014
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Fax | 516-414-4012
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAHENDRA SHARMA
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Credential | M.D.
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Telephone | 516-625-1014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 1988231
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License Number State | NY
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