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General NPI Number Information
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NPI Number | 1588489918
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Entity Type | Organization
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Legal Business Name | ISLAND GASTROENTEROLOGY CONSULTANTS PC
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 631 MONTAUK HWY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4400
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Country | US
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Telephone | 631-806-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 MONTAUK HWY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4910
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Country | US
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Telephone | 631-669-1171
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAJKUMAR G MARIWALLA
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Credential | MD
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Telephone | 631-669-1171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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