Organization
STATEN ISLAND MEDICAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSEMARIE PHILLIP MD (MEDICAL DIRECTOR)
(201) 857-4011
Entity
Organization
Contact information
Practice address
2071 CLOVE RD, STATEN ISLAND, NY 10304-1612
(718) 391-0303
Mailing address
PO BOX 581, SADDLE RIVER, NJ 07458-0581
(201) 857-4011
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
4431
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4431
AAAASF
NY
Enumeration date
06/28/2012
Last updated
06/28/2012
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