Provider Demographics
NPI:1538487525
Name:RICKY J SAYEGH M.D.P.C.
Entity Type:Organization
Organization Name:RICKY J SAYEGH M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-376-7000
Mailing Address - Street 1:235 PARK AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2405
Mailing Address - Country:US
Mailing Address - Phone:914-376-7000
Mailing Address - Fax:914-423-6883
Practice Address - Street 1:909 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1092
Practice Address - Country:US
Practice Address - Phone:914-376-7000
Practice Address - Fax:914-423-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227084302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02458313Medicaid
NY10345PMedicare UPIN
NY004SD1Medicare PIN