Provider Demographics
NPI:1730181082
Name:SIGNATURE HEALTH CENTER, LLC
Entity type:Organization
Organization Name:SIGNATURE HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:B
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-683-3900
Mailing Address - Street 1:PO BOX 7610
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-0726
Mailing Address - Country:US
Mailing Address - Phone:516-683-3900
Mailing Address - Fax:516-683-2184
Practice Address - Street 1:220 E 161ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3528
Practice Address - Country:US
Practice Address - Phone:718-537-5000
Practice Address - Fax:718-537-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01998778Medicaid
NYWK8081Medicare PIN
NYWK8082Medicare PIN
NYWK8083Medicare PIN
NYWK9483Medicare PIN
NY1317560001Medicare NSC