Provider Demographics
NPI:1790724615
Name:ENDOVASCULAR ASSOCIATES OF NEW YORK
Entity Type:Organization
Organization Name:ENDOVASCULAR ASSOCIATES OF NEW YORK
Other - Org Name:ENDOVASCULAR ASSOCIATE OF NEW YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-838-3055
Mailing Address - Street 1:20 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7902
Mailing Address - Country:US
Mailing Address - Phone:212-838-3055
Mailing Address - Fax:
Practice Address - Street 1:20 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7902
Practice Address - Country:US
Practice Address - Phone:212-838-3055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1514842086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEP751Medicare ID - Type Unspecified