Provider Demographics
NPI:1053323386
Name:GAMIL KOSTANDY PHYSICIAN PC
Entity Type:Organization
Organization Name:GAMIL KOSTANDY PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GAMIL
Authorized Official - Middle Name:SAAD
Authorized Official - Last Name:KOSTANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-238-4441
Mailing Address - Street 1:411 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2663
Mailing Address - Country:US
Mailing Address - Phone:718-238-4441
Mailing Address - Fax:
Practice Address - Street 1:1435 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3403
Practice Address - Country:US
Practice Address - Phone:718-238-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01663327Medicaid
NYWDN151Medicare PIN
NY01663327Medicaid