Provider Demographics
NPI:1609953660
Name:SINCLAIR, TREVOR HOMER (PA)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:HOMER
Last Name:SINCLAIR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COMMUNITY DRIVE
Mailing Address - Street 2:PROVIDER ENROLLMENT UNIT
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:516-562-1000
Mailing Address - Fax:516-465-1890
Practice Address - Street 1:300 COMMUNITY DRIVE
Practice Address - Street 2:DEPARTMENT OF UROLOGY - NORTH SHORE UNIVERSITY HOSPITAL
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-562-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007846363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid
NY00330128Medicare ID - Type Unspecified