Healthcare Provider Details

I. General information

NPI: 1043628282
Provider Name (Legal Business Name): SOUTH ISLAND GASTROENTEROLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 WASHINGTON AVE
LAWRENCE NY
11559-1669
US

IV. Provider business mailing address

743 BRYANT ST
WOODMERE NY
11598-2904
US

V. Phone/Fax

Practice location:
  • Phone: 516-650-4604
  • Fax: 800-557-3140
Mailing address:
  • Phone: 516-650-4604
  • Fax: 800-557-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN L KADISH
Title or Position: PHYSICIAN / OWNER - INCORPORATOR
Credential: MD
Phone: 516-984-6472