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General NPI Number Information
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NPI Number | 1467087627
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Entity Type | Organization
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Legal Business Name | SJ SURGERY OF NY, PC
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/15/2020
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Provider Practice Location Address
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Address Line | 1111 MONTAUK HWY STE 2-2
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City | WEST ISLIP
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State | NY
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Zip | 11795-4910
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Country | US
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Telephone | 917-568-8540
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 512
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City | SMITHTOWN
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State | NY
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Zip | 11787-0512
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Country | US
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Telephone | 917-568-8540
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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. SANG H JHO
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Credential | MD
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Telephone | 917-568-8540
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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 |
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License Number State |
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