MEDICARE: GLEN OAKS MEDICAL ASSOCIATE 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

General Provider Information

NPI Number	:	1518140003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEN OAKS MEDICAL ASSOCIATE PC

Provider Business Mailing Address
First Line	:	25710 UNION TPKE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1252
Country	:	US
Telephone Number	:	718-343-7200
Fax Number	:	718-343-5834

Provider Business Practice Location Address
First Line	:	25710 UNION TPKE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1252
Country	:	US
Telephone Number	:	718-343-7200
Fax Number	:	718-343-5834

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. SHARAD SONI
Credential	:	M.D.
Telephone Number	:	516-376-7778

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/07/2007

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