Provider Demographics
NPI:1922252733
Name:SAUL M. MODLIN M.D., P.C.
Entity Type:Organization
Organization Name:SAUL M. MODLIN M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:UELI
Authorized Official - Middle Name:PIO
Authorized Official - Last Name:LAENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-737-4168
Mailing Address - Street 1:300 GARDEN CITY PLZ
Mailing Address - Street 2:SUITE 248
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3302
Mailing Address - Country:US
Mailing Address - Phone:631-737-4168
Mailing Address - Fax:631-737-2180
Practice Address - Street 1:300 GARDEN CITY PLZ
Practice Address - Street 2:SUITE 248
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3302
Practice Address - Country:US
Practice Address - Phone:631-737-4168
Practice Address - Fax:631-737-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF38829174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100020765Medicare PIN
NYF38829Medicare UPIN