Provider Demographics
NPI:1215103486
Name:SOMIDIL MEDICAL PC
Entity type:Organization
Organization Name:SOMIDIL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CODING/COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN CCSP
Authorized Official - Phone:845-634-6500
Mailing Address - Street 1:17 SQUADRON BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5214
Mailing Address - Country:US
Mailing Address - Phone:845-634-6500
Mailing Address - Fax:845-634-9424
Practice Address - Street 1:15 TWIN PONDS LN
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-1004
Practice Address - Country:US
Practice Address - Phone:845-634-6500
Practice Address - Fax:845-634-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2119612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01877614Medicaid
NY61M002Medicare PIN