| Sisselman Medical Group, Pc | |
|
627 Broadway Suite 1 Massapequa NY 11758-5031 | |
| (516) 308-4040 | |
| (516) 804-6386 |
| Full Name | Sisselman Medical Group, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 627 Broadway, Massapequa, New York |
| Authorized Official Name and Position | Stephen Sisselman (PRESIDENT) |
| Authorized Official Contact | 5163084040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sisselman Medical Group, Pc 627 Broadway Suite 1 Massapequa NY 11758-5031 Ph: (516) 308-4040 | Sisselman Medical Group, Pc 627 Broadway Suite 1 Massapequa NY 11758-5031 Ph: (516) 308-4040 |
| NPI Number | 1851572358 |
|---|---|
| Provider Enumeration Date | 11/26/2007 |
| Last Update Date | 10/12/2022 |
| Medicare PECOS PAC ID | 4284715269 |
|---|---|
| Medicare Enrollment ID | O20080116000062 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851572358 | NPI | - | NPPES |
| 05215494 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 216154 (New York) | Secondary |
| 207R00000X | Internal Medicine | 216161 (New York) | Primary |
| Provider Name | Stephen G Sisselman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609948884 PECOS PAC ID: 6204732464 Enrollment ID: I20031209000489 |
| Provider Name | Jill Sisselman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295895480 PECOS PAC ID: 9638250616 Enrollment ID: I20080116000071 |
| Provider Name | Amy L Roberts |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083904494 PECOS PAC ID: 0547483562 Enrollment ID: I20140520002448 |
| Provider Name | Sabrina S Mackittrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699196683 PECOS PAC ID: 9234359175 Enrollment ID: I20140929000275 |
| Provider Name | Lauren Iarrobino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710362728 PECOS PAC ID: 1456653583 Enrollment ID: I20160107000148 |
| Provider Name | Barbara Ferrara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629514674 PECOS PAC ID: 6406123165 Enrollment ID: I20170531000302 |
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