MEDICARE: WOODMERE MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	200548	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467721068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODMERE MEDICAL PC

Provider Business Mailing Address
First Line	:	PO BOX 439
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-0439
Country	:	US
Telephone Number	:	718-745-1901
Fax Number	:	718-745-5731

Provider Business Practice Location Address
First Line	:	8600 SHORE FRONT PKWY
Second Line	:
City	:	ROCKAWAY BEACH
State	:	NY
Zip	:	11693-1828
Country	:	US
Telephone Number	:	718-745-1901
Fax Number	:	718-745-5731

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUBODH KUMAR SINHA
Credential	:	MD
Telephone Number	:	718-745-1901

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	12/28/2011

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Directions to “WOODMERE MEDICAL PC ” Practice Location

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