Organization
ISLAND PULMONARY AND CRITICAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDISON GENARO GAVILANES MD (OWNER)
(631) 730-7375
Entity
Organization
Contact information
Practice address
50 SOUTHVIEW CIR, LAKE GROVE, NY 11755-2239
(631) 730-7375
Mailing address
50 SOUTHVIEW CIR, LAKE GROVE, NY 11755-2239
(631) 730-7375
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Enumeration date
03/05/2025
Last updated
04/28/2025
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