Provider Demographics
NPI:1043628282
Name:SOUTH ISLAND GASTROENTEROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTH ISLAND GASTROENTEROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER - INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KADISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-984-6472
Mailing Address - Street 1:743 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2904
Mailing Address - Country:US
Mailing Address - Phone:516-650-4604
Mailing Address - Fax:800-557-3140
Practice Address - Street 1:141 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1669
Practice Address - Country:US
Practice Address - Phone:516-650-4604
Practice Address - Fax:800-557-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty