Individual
DR. GITA VATANDOUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 226-6902
(718) 226-6844
Mailing address
1 EDGEWATER ST, 6TH FL., STATEN ISLAND, NY 10305-4900
(718) 226-1008
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
248813
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02822791
—
NY
05
—
34533500
—
WI
01
—
P00388754
RAILROAD MEDICARE
NY
Enumeration date
01/19/2006
Last updated
06/18/2009
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