Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Staten Island Medical Professional PC

Organization Internal Medicine Physician · NPI 1659676963

Staten Island Medical Professional PC is an Internal Medicine Physician in Staten Island, New York. Licensed in New York. Registered with an NPI since 2011.

Licensed in
NY
In the registry since
2011
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5405 Hylan Blvd
Staten Island, NY 10312-5241
Phone: (718) 356-0207
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 097198 (NY)

Record details

NPI number1659676963
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Edwin Gordon — Owner · (718) 356-0207
NPI enumeratedJanuary 18, 2011
Last updated in NPPESJanuary 18, 2011
Mailing address5405 Hylan Blvd, Staten Island, NY 10312-5241

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