Provider Demographics
NPI:1316629892
Name:SUNRISE MED LLC
Entity type:Organization
Organization Name:SUNRISE MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURLYANDCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-603-0509
Mailing Address - Street 1:1000 BOSTON POST RD # 1015
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2142
Mailing Address - Country:US
Mailing Address - Phone:203-872-2131
Mailing Address - Fax:207-419-7179
Practice Address - Street 1:130 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418
Practice Address - Country:US
Practice Address - Phone:203-872-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)