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General NPI Number Information
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NPI Number | 1336860733
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Entity Type | Organization
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Legal Business Name | SG MEDICAL PC
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 25 W 39TH ST FL 8
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City | NEW YORK
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State | NY
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Zip | 10018-4073
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Country | US
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Telephone | 917-565-8540
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Fax |
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Provider Business Mailing Address
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Address Line | 25 W 39TH ST FL 8
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City | NEW YORK
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State | NY
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Zip | 10018-4073
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Country | US
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Telephone | 917-565-8540
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY MULCARE
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Credential | MD
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Telephone | 203-912-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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