Provider Demographics
NPI:1154048395
Name:PRIME ENT SINUS SLEEP & ALLERGY INC
Entity type:Organization
Organization Name:PRIME ENT SINUS SLEEP & ALLERGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHILPA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-595-2033
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1450
Mailing Address - Country:US
Mailing Address - Phone:209-315-0400
Mailing Address - Fax:209-314-6455
Practice Address - Street 1:1503 E MARCH LN STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5622
Practice Address - Country:US
Practice Address - Phone:209-315-0400
Practice Address - Fax:209-314-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty