Healthcare Provider Details

I. General information

NPI: 1306374939
Provider Name (Legal Business Name): IAN CHARLES GILCHRIST JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 OLD COUNTRY RD
PLAINVIEW NY
11803-4914
US

IV. Provider business mailing address

888 OLD COUNTRY RD
PLAINVIEW NY
11803-4914
US

V. Phone/Fax

Practice location:
  • Phone: 516-719-3000
  • Fax:
Mailing address:
  • Phone: 516-719-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number312617
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: