MEDICARE: LONG BEACH VASCULAR GEN SUR

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	174400000X	Specialist	202814	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932125457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH VASCULAR GEN SUR

Provider Business Mailing Address
First Line	:	711 LINCOLN BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2315
Country	:	US
Telephone Number	:	516-432-1094
Fax Number	:	516-432-1095

Provider Business Practice Location Address
First Line	:	711 LINCOLN BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2315
Country	:	US
Telephone Number	:	516-432-1094
Fax Number	:	516-432-1095

Authorized Official
Title or Position	:	SOLE PROPIETER
Name	:	NEYSA VALENTIN-CAPELES
Credential	:	MD
Telephone Number	:	516-432-1094

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	01/21/2008

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Directions to “LONG BEACH VASCULAR GEN SUR ” Practice Location

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