Provider Demographics
NPI:1588802292
Name:LONG ISLAND VASCULAR AND ENDOVASCULAR SURGERY PC
Entity Type:Organization
Organization Name:LONG ISLAND VASCULAR AND ENDOVASCULAR SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-298-7720
Mailing Address - Street 1:50 ROUTE 111
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3738
Mailing Address - Country:US
Mailing Address - Phone:631-298-7720
Mailing Address - Fax:631-298-7721
Practice Address - Street 1:300 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2900
Practice Address - Country:US
Practice Address - Phone:631-298-7720
Practice Address - Fax:631-298-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2372542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty