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General NPI Number Information
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NPI Number | 1508244104
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Entity Type | Organization
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Legal Business Name | GLOBAL HEALTH ADVANTAGE, INC
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 24739 JERICHO TPKE
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City | BELLEROSE
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State | NY
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Zip | 11426-1541
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Country | US
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Telephone | 718-343-2045
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Fax |
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Provider Business Mailing Address
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Address Line | 250 COOK ST
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-3504
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Country | US
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Telephone | 718-343-2045
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVE C IDEYI
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Credential | MD
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Telephone | 718-343-2045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 230744
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License Number State | NY
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