Organization
EMERGENCY MEDICINE SERVICES OF STATEN ISLAND, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAHIM ARDOLIC MD (DIRECTOR)
(718) 226-9158
Entity
Organization
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 226-9158
Mailing address
1 EDGEWATER STREET, 6TH FLOOR, STATEN ISLAND, NY 10305
(718) 226-1013
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
—
—
363A00000X
Physician Assistant
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02244851
—
NY
01
—
CJ7965
RR MEDICARE #
NY
Enumeration date
07/13/2006
Last updated
04/03/2009
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