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General NPI Number Information
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NPI Number | 1619167277
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Entity Type | Organization
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Legal Business Name | SUNRISE MEDICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 30 EAST SUNRISE HIGHWAY SUITE 108
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City | VALLEY STREAM
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State | NY
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Zip | 11581
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Country | US
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Telephone | 516-791-5804
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Fax | 516-791-5809
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Provider Business Mailing Address
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Address Line | 30 EAST SUNRISE HIGHWAY SUITE 108
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City | VALLEY STREAM
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State | NY
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Zip | 11581
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Country | US
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Telephone | 516-791-5804
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Fax | 516-791-5809
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HAROLD K. SIROTA
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Credential | D.O.
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Telephone | 516-791-5804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 171751
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 582205
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 175418
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License Number State | NY
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