Healthcare Provider Details

I. General information

NPI: 1285290775
Provider Name (Legal Business Name): CROSS ISLAND MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13525 79TH ST
HOWARD BEACH NY
11414-1010
US

IV. Provider business mailing address

13525 79TH ST
HOWARD BEACH NY
11414-1010
US

V. Phone/Fax

Practice location:
  • Phone: 917-903-3885
  • Fax:
Mailing address:
  • Phone: 917-903-3885
  • Fax:

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 Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HIMANSHU PANDYA
Title or Position: PRESIDENT
Credential: MD
Phone: 917-903-3885