Provider Demographics
NPI:1558348003
Name:51 SANDALWOOD ENTERPRISES, INC
Entity Type:Organization
Organization Name:51 SANDALWOOD ENTERPRISES, INC
Other - Org Name:MCGUIRE'S HEARING AID SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZENKER
Authorized Official - Suffix:
Authorized Official - Credentials:AA
Authorized Official - Phone:631-447-7938
Mailing Address - Street 1:20 MEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1220
Mailing Address - Country:US
Mailing Address - Phone:631-447-7938
Mailing Address - Fax:631-447-7939
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-758-3709
Practice Address - Fax:631-758-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000004914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01549022Medicaid
NYM1W591Medicare ID - Type Unspecified