Provider Demographics
NPI:1265237085
Name:SUN MOUNTAIN MEDICAL PLLC
Entity type:Organization
Organization Name:SUN MOUNTAIN MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATHARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-400-3941
Mailing Address - Street 1:565 JEWETT AVE BSMT MEDICAL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2654
Mailing Address - Country:US
Mailing Address - Phone:917-400-3941
Mailing Address - Fax:718-447-7831
Practice Address - Street 1:4140 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3584
Practice Address - Country:US
Practice Address - Phone:917-400-3941
Practice Address - Fax:718-447-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty