Provider Demographics
NPI:1518140003
Name:GLEN OAKS MEDICAL ASSOCIATE PC
Entity Type:Organization
Organization Name:GLEN OAKS MEDICAL ASSOCIATE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-376-7778
Mailing Address - Street 1:25710 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1252
Mailing Address - Country:US
Mailing Address - Phone:718-343-7200
Mailing Address - Fax:718-343-5834
Practice Address - Street 1:25710 UNION TPKE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1252
Practice Address - Country:US
Practice Address - Phone:718-343-7200
Practice Address - Fax:718-343-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty