Provider Demographics
NPI:1033815915
Name:STATEN ISLAND GSC LLC
Entity Type:Organization
Organization Name:STATEN ISLAND GSC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-450-4870
Mailing Address - Street 1:2043 RICHMOND AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3964
Mailing Address - Country:US
Mailing Address - Phone:718-975-7574
Mailing Address - Fax:
Practice Address - Street 1:2043 RICHMOND AVE FL 1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3964
Practice Address - Country:US
Practice Address - Phone:718-975-7574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical