=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326336363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYNERGY HEALTH MEDICAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2011
-----------------------------------------------------
Last Update Date | 10/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 CLINTON ST
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-280-2022
-----------------------------------------------------
Fax | 516-538-8988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95 CLINTON ST
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-280-2022
-----------------------------------------------------
Fax | 516-538-8988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MAX NOEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 516-280-2022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------