Provider Demographics
NPI:1972656437
Name:ISLAND SURGICAL PRACTICE PC
Entity Type:Organization
Organization Name:ISLAND SURGICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVENDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRAHMBHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-568-9119
Mailing Address - Street 1:446 HUNGRY HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3645
Mailing Address - Country:US
Mailing Address - Phone:516-568-9119
Mailing Address - Fax:516-568-9800
Practice Address - Street 1:210 E SUNRISE HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1329
Practice Address - Country:US
Practice Address - Phone:516-568-9119
Practice Address - Fax:516-568-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDG5352Medicare PIN
NY08281Medicare PIN
NYB94867Medicare UPIN
NYWWP221Medicare PIN