# SUN MOUNTAIN MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265237085
- **Authorized official:** DR. SHAILESH S PATHARE MD (PRESIDENT)
- **Authorized official phone:** (917) 400-3941

## Contact information

- **Practice address:** 4140 JUNCTION BLVD, CORONA, NY 11368-3584
- **Practice address phone:** (917) 400-3941
- **Practice address fax:** (718) 447-7831
- **Mailing address:** 565 JEWETT AVE BSMT MEDICAL, STATEN ISLAND, NY 10302-2654
- **Mailing address phone:** (917) 400-3941
- **Mailing address fax:** (718) 447-7831

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |
| 2083A0300X | Addiction Medicine (Preventive Medicine) Physician | — | NULL | — |
| 2083A0300X | Addiction Medicine (Preventive Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 02/17/2025
- **Last updated:** 02/17/2025