Provider Demographics
NPI:1710020417
Name:STATMD PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:STATMD PHYSICIANS, PLLC
Other - Org Name:STATMD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-352-7828
Mailing Address - Street 1:2090 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4719
Mailing Address - Country:US
Mailing Address - Phone:516-352-7828
Mailing Address - Fax:516-352-7827
Practice Address - Street 1:2090 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4719
Practice Address - Country:US
Practice Address - Phone:516-352-7828
Practice Address - Fax:516-352-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WEW491Medicare PIN