Provider Demographics
NPI:1619060183
Name:SIROTA, HAROLD K (DO)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:K
Last Name:SIROTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EAST SUNRISE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581
Mailing Address - Country:US
Mailing Address - Phone:516-791-5804
Mailing Address - Fax:516-791-5809
Practice Address - Street 1:30 EAST SUNRISE HIGHWAY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581
Practice Address - Country:US
Practice Address - Phone:516-791-5804
Practice Address - Fax:516-791-5809
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01147906Medicaid
NY01147906Medicaid
E47694Medicare UPIN
30F911Medicare PIN