Healthcare Provider Details

I. General information

NPI: 1174695068
Provider Name (Legal Business Name): GENERAL AND VASCULAR SURGERY OF LONG ISLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 ROCKAWAY AVE
BROOKLYN NY
11212-5636
US

IV. Provider business mailing address

520 FRANKLIN AVE SUITE 151
GARDEN CITY NY
11530-5801
US

V. Phone/Fax

Practice location:
  • Phone: 718-346-2628
  • Fax: 516-248-3044
Mailing address:
  • Phone: 516-746-3310
  • Fax: 516-746-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number163260
License Number StateNY

VIII. Authorized Official

Name: ANTHONY COLANTONIO
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 718-346-3355