MEDICARE: ISLAND SURGICAL GROUP, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	147085	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1205872702	OTHER	NY	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205872702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND SURGICAL GROUP, PC

Provider Business Mailing Address
First Line	:	1835 BAY RIDGE PKWY FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5706
Country	:	US
Telephone Number	:	718-238-6100
Fax Number	:	718-680-7969

Provider Business Practice Location Address
First Line	:	1835 BAY RIDGE PKWY FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5706
Country	:	US
Telephone Number	:	718-238-6100
Fax Number	:	718-680-7969

Authorized Official
Title or Position	:	MANAGER
Name	:	SARA JAHANGIR
Credential	:
Telephone Number	:	718-238-6100

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	03/17/2018

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Directions to “ISLAND SURGICAL GROUP, PC ” Practice Location

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