Island Surgical & Vascular Group, P.C.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

ISLAND SURGICAL & VASCULAR GROUP, P.C.

Practice address

15 Park Ave
Bay Shore, NY 11706-7381

Phone

(631) 581-4400

Fax

(631) 277-3750

NPI assigned

May 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bradley David Cohen, M.D.

Title

President

Phone

(631) 581-4400

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christine Ann Fanelli, NP

  • Family Nurse Practitioner
  • Bay Shore, NY
  • NPI 1689632622
  Medicare reassignment NPD
• Rachel Gordon

  • Surgery Physician
  • New Hyde Park, NY
  • NPI 1063703650
  Medicare reassignment NPD
• Charles A La Rosa, M.D.

  • Vascular Surgery Physician
  • Bay Shore, NY
  • NPI 1619900438
  Medicare reassignment NPD
• Alexander S Melman, M.D.

  • Surgery Physician
  • Bay Shore, NY
  • NPI 1821037698
  Medicare reassignment NPD
• Manal Hegazy, M.D.

  • Surgery Physician
  • Bay Shore, NY
  • NPI 1457380024
  Medicare reassignment
• Scott Christopher Wodicka, M.D.

  • Surgery Physician
  • Bay Shore, NY
  • NPI 1871539205
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259625600000",
    "number": "1639116759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PARK AVE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067381",
            "telephone_number": "631-581-4400",
            "fax_number": "631-277-3750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PARK AVE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067381",
            "telephone_number": "631-581-4400",
            "fax_number": "631-277-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND SURGICAL & VASCULAR GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2009-12-01",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-581-4400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00664668",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shon Anthony Isaacs Jr.
• Island Heart Associates, LLP
• Island Nephrology Consultants, P.C.
• Island Regional Physical Therapy PLLC
• Island Shore Physical Therapy LLP
• Island Wide Ambulette Services Inc (Health Beat Ambulance)
• Islandmed Inc.
• Islandwide Medical PLLC
• Brandon Isolano, PA
• Doron Israelski, MD

• Surgery Physician in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.