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General NPI Number Information
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NPI Number | 1962752527
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Entity Type | Organization
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Legal Business Name | GOLD COAST MEDICAL P C
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 237 JERICHO TURNPIKE
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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 | 516-584-6400
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Fax | 516-584-6401
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Provider Business Mailing Address
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Address Line | P O BOX 270
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-0270
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Country | US
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Telephone | 631-264-2035
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Fax | 631-264-1418
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Authorized Official
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Title or Position | OWNER
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Name | KOSTAS SIDERIDIS
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Credential | D.O.
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Telephone | 516-584-6400
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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 |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 220299
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License Number State | NY
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