Healthcare Provider Details

I. General information

NPI: 1588657415
Provider Name (Legal Business Name): GAGARINI TITOV ESPINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GAGARINI TITOV ESPINO-RODRIGUEZ MD

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST LENOX HILL HOSPITAL, RADIOLOGY DEPARTMENT, 3RD FLOOR
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

100 E 77TH ST LENOX HILL HOSPITAL, RADIOLOGY DEPARTMENT, 3RD FLOOR
NEW YORK NY
10075-1850
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2685
  • Fax: 212-434-2945
Mailing address:
  • Phone: 212-434-2685
  • Fax: 212-434-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD432789
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD432789
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number180989
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD432789
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD432789
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: