Provider Demographics
NPI:1487957692
Name:HARLEM MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:HARLEM MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENTYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-675-9300
Mailing Address - Street 1:45 RESEARCH WAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6401
Mailing Address - Country:US
Mailing Address - Phone:631-675-9300
Mailing Address - Fax:631-675-9301
Practice Address - Street 1:506 MALCOLM X BLVD (LENOX AVE)
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:631-675-9300
Practice Address - Fax:631-675-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty