Provider Demographics
NPI:1407860471
Name:ISLAND CARDIOVASCULAR ASSOCIATES OF NY PC
Entity Type:Organization
Organization Name:ISLAND CARDIOVASCULAR ASSOCIATES OF NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:PRAKASH
Authorized Official - Last Name:GANGULY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-979-8880
Mailing Address - Street 1:496 SMITHTOWN BYP
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5005
Mailing Address - Country:US
Mailing Address - Phone:631-979-8880
Mailing Address - Fax:631-979-8064
Practice Address - Street 1:496 SMITHTOWN BYP
Practice Address - Street 2:SUITE 101
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5005
Practice Address - Country:US
Practice Address - Phone:631-979-8880
Practice Address - Fax:631-979-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW22441Medicare ID - Type Unspecified