Provider Demographics
NPI:1821042565
Name:SHARMA, SANJIV (MD)
Entity Type:Individual
Prefix:
First Name:SANJIV
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2810
Mailing Address - Country:US
Mailing Address - Phone:516-938-4592
Mailing Address - Fax:516-692-2683
Practice Address - Street 1:10 GERHARD RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5502
Practice Address - Country:US
Practice Address - Phone:516-938-4592
Practice Address - Fax:516-692-2683
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168070207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD92078Medicare UPIN
NY05F441Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER