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General NPI Number Information
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NPI Number | 1386855815
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Entity Type | Organization
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Legal Business Name | S.N.MEDICAL PLLC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 121 DEKALB AVE SUITE 11E
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City | BROOKLYN
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State | NY
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Zip | 11201-5425
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Country | US
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Telephone | 718-250-8866
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Fax | 718-250-8931
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Provider Business Mailing Address
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Address Line | 10 RODEO DR
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City | SYOSSET
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State | NY
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Zip | 11791-2209
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Country | US
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Telephone | 516-921-8150
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Fax | 718-250-8931
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Authorized Official
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Title or Position | PRESIDENT
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Name | BALAKRISHNA NULI
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Credential | M.D
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Telephone | 718-250-8992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 113659
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License Number State | NY
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