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General NPI Number Information
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NPI Number | 1831462464
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Entity Type | Organization
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Legal Business Name | RAKESH SHARMA PHYSICIAN PC
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 122 PORTION RD SUITE 104
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-4174
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Country | US
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Telephone | 631-588-8393
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Fax | 631-588-2312
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Provider Business Mailing Address
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Address Line | 122 PORTION RD SUITE 104
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-4174
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Country | US
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Telephone | 631-588-8393
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Fax | 631-588-2312
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RAKESH SHARMA
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Credential | M.D.
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Telephone | 631-588-8393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 161670
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 161670
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License Number State | NY
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