Provider Demographics
NPI:1255305900
Name:SOUTHERN WESTCHESTER DIABETES, PC
Entity Type:Organization
Organization Name:SOUTHERN WESTCHESTER DIABETES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADEM
Authorized Official - Middle Name:JAMIL
Authorized Official - Last Name:SAYEGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-601-3300
Mailing Address - Street 1:226 W 238TH ST # A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2423
Mailing Address - Country:US
Mailing Address - Phone:718-601-3300
Mailing Address - Fax:
Practice Address - Street 1:226 W 238TH ST # A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2423
Practice Address - Country:US
Practice Address - Phone:718-601-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195964173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02176772Medicaid
NY02176772Medicaid