Healthcare Provider Details

I. General information

NPI: 1285775908
Provider Name (Legal Business Name): BG MEDICAL AND DIAGNOSTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 CLOVE RD
STATEN ISLAND NY
10304-1671
US

IV. Provider business mailing address

2071 CLOVE RD
STATEN ISLAND NY
10304-1671
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-5550
  • Fax:
Mailing address:
  • Phone: 718-442-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BILLY GERIS
Title or Position: PRESIDENT
Credential: MD
Phone: 718-442-5550