Healthcare Provider Details

I. General information

NPI: 1184805061
Provider Name (Legal Business Name): RIVERSIDE SURGICAL P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N BROADWAY SUITE 309
YONKERS NY
10701-1309
US

IV. Provider business mailing address

970 N BROADWAY SUITE 309
YONKERS NY
10701-1309
US

V. Phone/Fax

Practice location:
  • Phone: 914-965-0625
  • Fax: 914-965-0107
Mailing address:
  • Phone: 914-965-0625
  • Fax: 914-965-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number135684
License Number StateNY

VIII. Authorized Official

Name: DR. GOVINDAN GANDHI
Title or Position: PRESIDENT
Credential: M.D
Phone: 914-965-0625