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General NPI Number Information
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NPI Number | 1487067450
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Entity Type | Organization
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Legal Business Name | MERCY SIDE OF CARE MEDICAL SERVICES, PC
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Dates
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Enumeration Date | 06/08/2014
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Last Update Date | 06/08/2014
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Provider Practice Location Address
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Address Line | 8538 168TH PL
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City | JAMAICA
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State | NY
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Zip | 11432-2638
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Country | US
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Telephone | 347-390-0612
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Fax | 718-480-6652
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Provider Business Mailing Address
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Address Line | 50 NORTH DR
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City | MANHASSET HILLS
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State | NY
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Zip | 11040-2255
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Country | US
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Telephone | 516-248-0465
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SYEDUR R CHOWDHURY
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Credential | MD
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Telephone | 516-248-0465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 234238
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License Number State | NY
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