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General NPI Number Information
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NPI Number | 1689845315
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Entity Type | Organization
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Legal Business Name | IDAN SHARON, MD, PC
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Dates
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Enumeration Date | 03/20/2008
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 345 SEAVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-2244
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Country | US
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Telephone | 718-680-8105
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Fax | 718-680-6556
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Provider Business Mailing Address
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Address Line | 398 BOND ST
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City | BROOKLYN
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State | NY
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Zip | 11231-4812
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Country | US
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Telephone | 718-680-8105
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Fax | 718-680-6556
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | IDAN SHARON
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Credential | MD
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Telephone | 718-680-8105
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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 | 197670
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License Number State | NY
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