Provider Demographics
NPI:1609947191
Name:BATOON, SHERWIN (MD)
Entity Type:Individual
Prefix:
First Name:SHERWIN
Middle Name:
Last Name:BATOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14714 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1704
Mailing Address - Country:US
Mailing Address - Phone:718-762-4946
Mailing Address - Fax:718-762-1495
Practice Address - Street 1:147-14 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2205
Practice Address - Country:US
Practice Address - Phone:718-762-4946
Practice Address - Fax:718-762-1495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214818207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02039912Medicaid
NYG400056331Medicare PIN
NYH07008Medicare UPIN