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Organization
SISSELMAN MEDICAL GROUP, PC
Active
Organization
SISSELMAN MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN SISSELMAN D.O. (PRESIDENT)
(516) 308-4040
Entity
Organization
Contact information
Practice address
627 BROADWAY, SUITE 1, MASSAPEQUA, NY 11758-5031
(516) 308-4040
(516) 804-6386
Mailing address
627 BROADWAY, SUITE 1, MASSAPEQUA, NY 11758-5031
(516) 308-4040
(516) 804-6386
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
216154
NY
207R00000X
Internal Medicine Physician
Primary
216161
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05215494
—
NY
Enumeration date
11/26/2007
Last updated
10/12/2022
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