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General NPI Number Information
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NPI Number | 1851572358
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Entity Type | Organization
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Legal Business Name | SISSELMAN MEDICAL GROUP, PC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 627 BROADWAY SUITE 1
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5031
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Country | US
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Telephone | 516-308-4040
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Fax | 516-804-6386
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Provider Business Mailing Address
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Address Line | 627 BROADWAY SUITE 1
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5031
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Country | US
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Telephone | 516-308-4040
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Fax | 516-804-6386
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN SISSELMAN
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Credential | D.O.
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Telephone | 516-308-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 216154
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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 | 216161
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License Number State | NY
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