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Organization
ISLAND MEDICAL SPECIALISTS, P.L.L.C.
Active
Organization
ISLAND MEDICAL SPECIALISTS, P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI GUTERMAN (CREDENTIALING COORDINATOR)
(718) 876-6220
Entity
Organization
Contact information
Practice address
2627 HYLAN BLVD STE C, STATEN ISLAND, NY 10306-4344
(718) 351-1136
(718) 667-9711
Mailing address
2627 HYLAN BLVD STE C, STATEN ISLAND, NY 10306-4344
(718) 351-1136
(718) 667-9711
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NY
207RC0000X
Cardiovascular Disease Physician
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02679945
—
NY
Enumeration date
10/07/2005
Last updated
12/21/2022
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