MEDICARE: DR. GAGARINI TITOV ESPINO MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	MD432789	PA
2	2085N0904X	Nuclear Radiology Physician	MD432789	PA
3	2085R0202X	Diagnostic Radiology Physician	180989	NY
4	2085R0202X	Diagnostic Radiology Physician	MD432789	PA
5	2085R0204X	Vascular & Interventional Radiology Physician	MD432789	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	919374	OTHER	MD	CAREFIRST MD BCBS-WMG
2	2076065	OTHER	PA	HIGHMARK BLUE SHIELD-WMG
3	258292	OTHER	PA	UNISON
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1583308	OTHER	PA	GATEWAY-WMG
8	20077142	OTHER	PA	AMERIHEALTH MERCY-WMG
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1588657415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAGARINI TITOV ESPINO MD

Provider Business Mailing Address
First Line	:	100 E 77TH ST
Second Line	:	LENOX HILL HOSPITAL, RADIOLOGY DEPARTMENT, 3RD FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10075-1850
Country	:	US
Telephone Number	:	212-434-2685
Fax Number	:	212-434-2945

Provider Business Practice Location Address
First Line	:	100 E 77TH ST
Second Line	:	LENOX HILL HOSPITAL, RADIOLOGY DEPARTMENT, 3RD FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10075-1850
Country	:	US
Telephone Number	:	212-434-2685
Fax Number	:	212-434-2945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	10/13/2014

10 UNION SQ E , BETH ISRAEL MED CTR- DEPT OF REHAB MEDICARE
NEW YORK, NY
10003-3314

Practice Phone: 212-420-2757
Practice Fax: