Provider Demographics
NPI:1356380844
Name:SBC MEDICAL PLLC
Entity type:Organization
Organization Name:SBC MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-263-7161
Mailing Address - Street 1:C/O STEPHEN B. COLVIN, M.D.
Mailing Address - Street 2:530 FIRST AVENUE, SUITE 9V
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-263-7161
Mailing Address - Fax:
Practice Address - Street 1:LIBERTY HEALTH CENTER
Practice Address - Street 2:106 LIBERTY STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1008
Practice Address - Country:US
Practice Address - Phone:212-227-7227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107411174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty