Provider Demographics
NPI:1700954906
Name:SAWKILL FAMILY MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:SAWKILL FAMILY MEDICAL ASSOCIATES PC
Other - Org Name:SAWKILL FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAFRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-339-4667
Mailing Address - Street 1:501 HURLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443
Mailing Address - Country:US
Mailing Address - Phone:845-339-4667
Mailing Address - Fax:845-339-4668
Practice Address - Street 1:501 HURLEY AVENUE
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12443
Practice Address - Country:US
Practice Address - Phone:845-339-4667
Practice Address - Fax:845-339-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5395OtherCDPHP
52284OtherMVP
52284OtherMVP