Provider Demographics
NPI:1073858742
Name:HARBOR MEDICAL CARE PC
Entity Type:Organization
Organization Name:HARBOR MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-928-2002
Mailing Address - Street 1:116 TERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1329
Mailing Address - Country:US
Mailing Address - Phone:631-928-2002
Mailing Address - Fax:206-202-3956
Practice Address - Street 1:116 TERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1329
Practice Address - Country:US
Practice Address - Phone:631-928-2002
Practice Address - Fax:206-202-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238641261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care