Organization
SUN MOUNTAIN MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAILESH S PATHARE MD (PRESIDENT)
(917) 400-3941
Entity
Organization
Contact information
Practice address
4140 JUNCTION BLVD, CORONA, NY 11368-3584
(917) 400-3941
(718) 447-7831
Mailing address
565 JEWETT AVE BSMT MEDICAL, STATEN ISLAND, NY 10302-2654
(917) 400-3941
(718) 447-7831
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
—
—
Other
Enumeration date
02/17/2025
Last updated
02/17/2025
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