Provider Demographics
NPI:1174223515
Name:MINIMALLY INVASIVE CENTER OF NEW YORK LLC
Entity type:Organization
Organization Name:MINIMALLY INVASIVE CENTER OF NEW YORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-400-6184
Mailing Address - Street 1:100 MOTOR PKWY STE LL8
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5165
Mailing Address - Country:US
Mailing Address - Phone:833-547-7463
Mailing Address - Fax:
Practice Address - Street 1:66 COMMACK RD STE 103
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3405
Practice Address - Country:US
Practice Address - Phone:833-547-7463
Practice Address - Fax:631-248-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain