Provider Demographics
NPI:1487953717
Name:S&S MEDICAL, P.C
Entity type:Organization
Organization Name:S&S MEDICAL, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAZIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:163-185-3283
Mailing Address - Street 1:70-62 KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:718-544-0565
Mailing Address - Fax:718-544-0569
Practice Address - Street 1:70-62 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367
Practice Address - Country:US
Practice Address - Phone:718-544-0565
Practice Address - Fax:718-544-0569
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S&S MEDICAL P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240847207Q00000X
NY222749-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02838186Medicaid
NY02499585Medicaid
NY02838186Medicaid
NY9991815731Medicare NSC