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General NPI Number Information
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NPI Number | 1992296677
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Entity Type | Organization
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Legal Business Name | SGR MEDICAL DOCTOR P.C.
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 395 FORT WASHINGTON AVE SUITE 6
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City | NEW YORK
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State | NY
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Zip | 10033-6728
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Country | US
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Telephone | 212-928-1400
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Fax | 212-923-5595
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Provider Business Mailing Address
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Address Line | 395 FORT WASHINGTON AVE SUITE 6
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City | NEW YORK
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State | NY
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Zip | 10033-6728
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Country | US
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Telephone | 212-928-1400
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Fax | 212-923-5595
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Authorized Official
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Title or Position | PHYCOLOGY
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Name | XIOMARA M SANTOS
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Credential | M.D
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Telephone | 212-928-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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