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General NPI Number Information
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NPI Number | 1457085615
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Entity Type | Organization
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Legal Business Name | SG MEDICAL PROFESSIONAL PC
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 260 CHRISTOPHER LN STE 102A
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City | STATEN ISLAND
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State | NY
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Zip | 10314-1631
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Country | US
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Telephone | 718-362-1405
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Fax | 718-414-1651
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Provider Business Mailing Address
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Address Line | 45 S ROUTE 9W UNIT 41 #114
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City | WEST HAVERSTRAW
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State | NY
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Zip | 10993-1053
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Country | US
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Telephone | 631-759-9920
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Fax | 315-612-9793
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | DOV HOLLANDER
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Credential |
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Telephone | 631-759-9920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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