1356380844 NPI number — SBC MEDICAL PLLC

Table of content: (NPI 1356380844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356380844 NPI number — SBC MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SBC MEDICAL PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356380844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
C/O STEPHEN B. COLVIN, M.D.
Provider Second Line Business Mailing Address:
530 FIRST AVENUE, SUITE 9V
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-263-7161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LIBERTY HEALTH CENTER
Provider Second Line Business Practice Location Address:
106 LIBERTY STREET
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10006-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-227-7227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLVIN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-263-7161

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  107411 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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