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General NPI Number Information
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NPI Number | 1679731533
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Entity Type | Organization
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Legal Business Name | SDK LLC
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 05/28/2008
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Provider Practice Location Address
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Address Line | 650 NORTHERN BLVD
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City | GREAT NECK
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State | NY
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Zip | 11021-5204
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Country | US
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Telephone | 239-541-9993
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Fax |
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Provider Business Mailing Address
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Address Line | 650 NORTHERN BLVD
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City | GREAT NECK
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State | NY
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Zip | 11021-5204
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Country | US
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Telephone | 239-541-9993
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | ANA ORAMAS
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Credential |
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Telephone | 239-541-9993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 2478
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License Number State | NY
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