Provider Demographics
NPI:1598334534
Name:SYCAMORE MEDICAL PC
Entity Type:Organization
Organization Name:SYCAMORE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:NEWMAN
Authorized Official - Last Name:KROSNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-720-6930
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-0890
Mailing Address - Country:US
Mailing Address - Phone:516-417-7159
Mailing Address - Fax:
Practice Address - Street 1:70 GLEN ST STE 380
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2858
Practice Address - Country:US
Practice Address - Phone:305-720-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center