Provider Demographics
NPI:1528578747
Name:SEJAL KADAM MD P C
Entity Type:Organization
Organization Name:SEJAL KADAM MD P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-271-9151
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-0711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 STIRRUP LN
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4429
Practice Address - Country:US
Practice Address - Phone:631-271-9151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY233001-1OtherUNIV. STATE OF NEW YORK EDUCATION DEPT.