Provider Demographics
NPI:1205076890
Name:D. K. SIROTA, MD, PC
Entity type:Organization
Organization Name:D. K. SIROTA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KING
Authorized Official - Last Name:SIROTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-427-5600
Mailing Address - Street 1:1175 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1211
Mailing Address - Country:US
Mailing Address - Phone:212-427-5600
Mailing Address - Fax:845-680-6858
Practice Address - Street 1:1175 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1211
Practice Address - Country:US
Practice Address - Phone:212-427-5600
Practice Address - Fax:845-680-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086294207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00133440Medicaid
NY267961Medicare PIN