Basic Information
| Provider Information | |||||||||
| NPI: | 1003090093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHLOSSBERG | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 E SUNRISE HWY | ||||||||
| Address2: | 208 | ||||||||
| City: | LINDENHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117572598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312257200 | ||||||||
| FaxNumber: | 6319309451 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 E SUNRISE HWY | ||||||||
| Address2: | 208 | ||||||||
| City: | LINDENHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117572598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312257200 | ||||||||
| FaxNumber: | 6319309451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2007 | ||||||||
| LastUpdateDate: | 12/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 60240414 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | 60240414 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 02984150 | 05 | NY | MEDICAID |