Provider Demographics
NPI:1912191917
Name:SAULIUS J SKEIVYS MD PC
Entity Type:Organization
Organization Name:SAULIUS J SKEIVYS MD PC
Other - Org Name:WOODSIDE FAMILY HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAULIUS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SKEIVYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-639-3600
Mailing Address - Street 1:5718 WOODSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3444
Mailing Address - Country:US
Mailing Address - Phone:718-639-3600
Mailing Address - Fax:718-397-8049
Practice Address - Street 1:5718 WOODSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3444
Practice Address - Country:US
Practice Address - Phone:718-639-3600
Practice Address - Fax:718-397-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-02
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178908261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01527577Medicaid
NY01527577Medicaid