Provider Demographics
NPI:1881987584
Name:SATPAL RATHOUR MEDICINE PC
Entity type:Organization
Organization Name:SATPAL RATHOUR MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SATPAL
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:RATHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-949-8884
Mailing Address - Street 1:1250 WILLIAM FLOYD PKWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1809
Mailing Address - Country:US
Mailing Address - Phone:631-913-3529
Mailing Address - Fax:631-657-3273
Practice Address - Street 1:1250 WILLIAM FLOYD PKWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1809
Practice Address - Country:US
Practice Address - Phone:631-913-3529
Practice Address - Fax:631-657-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY253470OtherLICENSE
NY03246848Medicaid