Provider Demographics
NPI:1710261615
Name:ADVANCED SOUTHERN WESTCHESTER MEDICAL, PC
Entity Type:Organization
Organization Name:ADVANCED SOUTHERN WESTCHESTER MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERIF
Authorized Official - Middle Name:SABRY
Authorized Official - Last Name:EL-MASRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-375-5700
Mailing Address - Street 1:970 N BROADWAY STE 110
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1310
Mailing Address - Country:US
Mailing Address - Phone:914-375-5700
Mailing Address - Fax:914-375-5748
Practice Address - Street 1:1034 N BROADWAY
Practice Address - Street 2:2ND FLOOR, BOX #8
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1328
Practice Address - Country:US
Practice Address - Phone:914-375-5700
Practice Address - Fax:914-375-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY202685OtherLICENSE NUMBER