Provider Demographics
NPI:1619167277
Name:SUNRISE MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:SUNRISE MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIROTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-791-5804
Mailing Address - Street 1:30 EAST SUNRISE HIGHWAY
Mailing Address - Street 2:SUITE 108
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:SUITE 108
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175418207Q00000X
NY171751207R00000X
NY582205363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty