Provider Demographics
NPI:1154050615
Name:SUNRISE COMMUNITY CARE PC
Entity type:Organization
Organization Name:SUNRISE COMMUNITY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-551-1580
Mailing Address - Street 1:560 HUDSON ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6655
Mailing Address - Country:US
Mailing Address - Phone:201-287-1777
Mailing Address - Fax:212-888-6024
Practice Address - Street 1:9238 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047
Practice Address - Country:US
Practice Address - Phone:718-551-1580
Practice Address - Fax:212-888-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty