Provider Demographics
NPI:1043234271
Name:SUN, MINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-5200
Mailing Address - Country:US
Mailing Address - Phone:518-399-2233
Mailing Address - Fax:518-399-2951
Practice Address - Street 1:115 SARATOGA RD STE 200
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4224
Practice Address - Country:US
Practice Address - Phone:518-243-3360
Practice Address - Fax:518-243-3375
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1970281207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00092117OtherRAILROAD MEDICARE
NY03177066Medicaid
NYP00092117OtherRAILROAD MEDICARE