Provider Demographics
NPI:1114632825
Name:SG MEDICAL PROFESSIONALS CT PC
Entity Type:Organization
Organization Name:SG MEDICAL PROFESSIONALS CT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-362-1403
Mailing Address - Street 1:612 CORPORATE WAY STE 2M
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2027
Mailing Address - Country:US
Mailing Address - Phone:718-362-1403
Mailing Address - Fax:718-414-1651
Practice Address - Street 1:181 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3319
Practice Address - Country:US
Practice Address - Phone:718-362-1403
Practice Address - Fax:718-414-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty