Provider Demographics
NPI:1376542944
Name:SISKIND, STEVEN JAY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAY
Last Name:SISKIND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE L3A
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3028
Mailing Address - Country:US
Mailing Address - Phone:718-717-0238
Mailing Address - Fax:718-717-0265
Practice Address - Street 1:1155 NORTHERN BLVD STE 330
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3043
Practice Address - Country:US
Practice Address - Phone:516-627-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137378207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00665398Medicaid
NY00665398Medicaid
NYA400087131Medicare PIN
B88652Medicare UPIN