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General NPI Number Information
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NPI Number | 1528467685
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Entity Type | Organization
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Legal Business Name | GOLD COAST GASTROENTEROLOGY P.C.
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 237 JERICHO TPKE
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City | SYOSSET
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State | NY
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Zip | 11791-4513
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Country | US
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Telephone | 516-802-7555
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Fax | 516-802-7550
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Provider Business Mailing Address
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Address Line | 237 JERICHO TPKE
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City | SYOSSET
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State | NY
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Zip | 11791-4513
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Country | US
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Telephone | 516-802-7555
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Fax | 516-802-7550
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Authorized Official
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Title or Position | OWNER
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Name | MR. KOSTAS SIDERIDIS
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Credential | D.O
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Telephone | 516-802-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 238095
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 220299
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License Number State | NY
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