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General NPI Number Information
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NPI Number | 1619179314
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Entity Type | Organization
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Legal Business Name | PHOENIX MEDICAL CARE PC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 67 ANDREW ST
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City | MANHASSET
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State | NY
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Zip | 11030-2309
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Country | US
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Telephone | 516-627-6559
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Fax |
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Provider Business Mailing Address
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Address Line | 67 ANDREW ST
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City | MANHASSET
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State | NY
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Zip | 11030-2309
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Country | US
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Telephone |
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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. ROBERT SHARGANI
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Credential |
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Telephone | 516-627-7559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 221729
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License Number State | NY
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