Individual ProviderSire SowInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address17 E 102nd St, New York, NY 10029-5204(212) 659-8551(212) 987-3100PECOS EnrollmentBased on the most recent information from CMS, provider Sire Sow is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1427462381Provider TypeIndividualFull NameSow, SireGenderMaleSole ProprietorYesEnumeration Date6/18/2014Last Updated3/11/2019Contact InformationPractice LocationPractice Address17 E 102nd St, New York, NY 10029-5204Phone(212) 659-8551FaxUnlisted FaxMailing LocationMailing Address1 Gustave L Levy Pl # 3000, New York, NY 10029-6504Phone(212) 987-3100Fax(212) 731-5210Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense289852New York