1114809035 NPI number — NEW YORK CITY GASTROENTEROLOGY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114809035 NPI number — NEW YORK CITY GASTROENTEROLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK CITY GASTROENTEROLOGY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114809035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 GRAMERCY PARK N STE 1M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10010-5423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-254-2777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 GRAMERCY PARK N STE 1M
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-5423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-254-2777
Provider Business Practice Location Address Fax Number:
212-260-7177
Provider Enumeration Date:
07/22/2025

Additional Information

Authorized Official

Authorized Official Last Name:
OTTAVIANO
Authorized Official First Name:
LORENZO
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
212-254-2777

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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