Basic Information
| Provider Information | |||||||||
| NPI: | 1588657415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESPINO | ||||||||
| FirstName: | GAGARINI | ||||||||
| MiddleName: | TITOV | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ESPINO-RODRIGUEZ | ||||||||
| OtherFirstName: | GAGARINI | ||||||||
| OtherMiddleName: | TITOV | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 E 77TH ST | ||||||||
| Address2: | LENOX HILL HOSPITAL, RADIOLOGY DEPARTMENT, 3RD FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100751850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124342685 | ||||||||
| FaxNumber: | 2124342945 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E 77TH ST | ||||||||
| Address2: | LENOX HILL HOSPITAL, RADIOLOGY DEPARTMENT, 3RD FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100751850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124342685 | ||||||||
| FaxNumber: | 2124342945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 10/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | MD432789 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0904X | MD432789 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | 180989 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD432789 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | MD432789 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 919374 | 01 | MD | CAREFIRST MD BCBS-WMG | OTHER | 2076065 | 01 | PA | HIGHMARK BLUE SHIELD-WMG | OTHER | 258292 | 01 | PA | UNISON | OTHER | 01600004 | 05 | NY | MEDICAID | 035836300 | 05 | MD | MEDICAID | 001886747 | 05 | PA | MEDICAID | 1583308 | 01 | PA | GATEWAY-WMG | OTHER | 20077142 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER |