Provider Demographics
NPI:1174125330
Name:GARDINE, SYLVESTER
Entity type:Individual
Prefix:
First Name:SYLVESTER
Middle Name:
Last Name:GARDINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 HURTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2135
Mailing Address - Country:US
Mailing Address - Phone:631-780-2869
Mailing Address - Fax:
Practice Address - Street 1:72 HURTIN BLVD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2135
Practice Address - Country:US
Practice Address - Phone:631-780-2869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy