Provider Demographics
NPI:1871634253
Name:SPS MEDICAL PC
Entity Type:Organization
Organization Name:SPS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PREM
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-735-5522
Mailing Address - Street 1:141 MELANIE DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1436
Mailing Address - Country:US
Mailing Address - Phone:516-735-5522
Mailing Address - Fax:516-644-5385
Practice Address - Street 1:4250 HEMPSTEAD TPKE
Practice Address - Street 2:SUIITE 19
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-735-5522
Practice Address - Fax:516-644-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210715207R00000X
NY202133207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01919259Medicaid
NYDC2627OtherRAILROAD MEDICARE GROUP
NYWEV711Medicare PIN