MEDICARE: SIGNATURE HEALTH CENTER, LLC

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		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	:	1730181082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 7610
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-0726
Country	:	US
Telephone Number	:	516-683-3900
Fax Number	:	516-683-2184

Provider Business Practice Location Address
First Line	:	220 E 161ST ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-3528
Country	:	US
Telephone Number	:	718-537-5000
Fax Number	:	718-537-7021

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CRAIG B SANDERS
Credential	:
Telephone Number	:	516-683-3900

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/04/2008

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