Provider Demographics
NPI:1245724152
Name:WINTHROP COMMUNITY MEDICAL AFFILIATES PC
Entity type:Organization
Organization Name:WINTHROP COMMUNITY MEDICAL AFFILIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-663-8919
Mailing Address - Street 1:700 HICKSVILLE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 MINEOLA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4089
Practice Address - Country:US
Practice Address - Phone:516-663-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04867401Medicaid