Provider Demographics
NPI:1962434423
Name:ISLAND PALLIATIVE MEDICINE, P.C.
Entity type:Organization
Organization Name:ISLAND PALLIATIVE MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:HECTOR
Authorized Official - Last Name:CALVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-512-8951
Mailing Address - Street 1:26 RAILROAD AVE
Mailing Address - Street 2:#206
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2204
Mailing Address - Country:US
Mailing Address - Phone:516-512-8951
Mailing Address - Fax:
Practice Address - Street 1:26 RAILROAD AVE
Practice Address - Street 2:#206
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2204
Practice Address - Country:US
Practice Address - Phone:516-512-8951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWKW731Medicare ID - Type UnspecifiedLEGACY NUMBER