Provider Demographics
NPI:1487067450
Name:MERCY SIDE OF CARE MEDICAL SERVICES, PC
Entity type:Organization
Organization Name:MERCY SIDE OF CARE MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYEDUR
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-248-0465
Mailing Address - Street 1:50 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2255
Mailing Address - Country:US
Mailing Address - Phone:516-248-0465
Mailing Address - Fax:
Practice Address - Street 1:8538 168TH PL
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2638
Practice Address - Country:US
Practice Address - Phone:347-390-0612
Practice Address - Fax:718-480-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234238207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty