Provider Demographics
NPI:1588489918
Name:ISLAND GASTROENTEROLOGY CONSULTANTS PC
Entity type:Organization
Organization Name:ISLAND GASTROENTEROLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJKUMAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARIWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-669-1171
Mailing Address - Street 1:1111 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4910
Mailing Address - Country:US
Mailing Address - Phone:631-669-1171
Mailing Address - Fax:
Practice Address - Street 1:631 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4400
Practice Address - Country:US
Practice Address - Phone:631-806-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory