MEDICARE: SYCAMORE 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1598334534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYCAMORE MEDICAL PC

Provider Business Mailing Address
First Line	:	PO BOX 890
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-0890
Country	:	US
Telephone Number	:	516-417-7159
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 GLEN ST STE 380
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-2858
Country	:	US
Telephone Number	:	305-720-6930
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUDSON NEWMAN KROSNEY
Credential	:	MD
Telephone Number	:	305-720-6930

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	06/23/2021

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Directions to “SYCAMORE MEDICAL PC ” Practice Location

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