Provider Demographics
NPI:1699913145
Name:ST. DEMIAN MEDICAL PLLC
Entity type:Organization
Organization Name:ST. DEMIAN MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAROBEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-758-4520
Mailing Address - Street 1:174 BAY 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:718-758-4520
Mailing Address - Fax:
Practice Address - Street 1:5 IVY WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810
Practice Address - Country:US
Practice Address - Phone:718-758-4520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty