Provider Demographics
NPI:1386855815
Name:S.N.MEDICAL PLLC
Entity Type:Organization
Organization Name:S.N.MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BALAKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-250-8992
Mailing Address - Street 1:10 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2209
Mailing Address - Country:US
Mailing Address - Phone:516-921-8150
Mailing Address - Fax:718-250-8931
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:SUITE 11E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-8866
Practice Address - Fax:718-250-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113659208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00207070Medicaid
NY00207070Medicaid
NYB17698Medicare UPIN