Provider Demographics
NPI:1811162373
Name:SAYEGH & KUMP FAMILY MED PRACTICE PC
Entity type:Organization
Organization Name:SAYEGH & KUMP FAMILY MED PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-548-4560
Mailing Address - Street 1:530 W 236TH ST
Mailing Address - Street 2:1D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1748
Mailing Address - Country:US
Mailing Address - Phone:718-548-4568
Mailing Address - Fax:718-548-6959
Practice Address - Street 1:530 W 236TH ST
Practice Address - Street 2:1D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1748
Practice Address - Country:US
Practice Address - Phone:718-548-4568
Practice Address - Fax:718-548-6959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRC0855V161OtherBLUE CROSS BLUE SHIELD
0S06705410OtherBLUE CROSS BLUE SHIELD
NY5900147OtherGHI
NY01497007Medicaid
NYP00282495OtherRAILROAD RETIREMENT PLAN
NY640855V161Medicare PIN
NY670545V161Medicare PIN