MEDICARE: MERCY SIDE OF CARE MEDICAL SERVICES 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	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1932587011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY SIDE OF CARE MEDICAL SERVICES PC

Provider Business Mailing Address
First Line	:	50 NORTH DR
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2255
Country	:	US
Telephone Number	:	718-200-0723
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 NORTH DR
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2255
Country	:	US
Telephone Number	:	718-200-0723
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	SYEDUR R CHOWDHURY
Credential	:
Telephone Number	:	718-200-0723

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	05/11/2015

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Directions to “MERCY SIDE OF CARE MEDICAL SERVICES PC ” Practice Location

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