1659827285 NPI number — DIGESTIVE CARE AND ENDOSCOPY, PLLC

Table of content: (NPI 1659827285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659827285 NPI number — DIGESTIVE CARE AND ENDOSCOPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE CARE AND ENDOSCOPY, PLLC
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:
6
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:
1659827285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10816 72ND AVE
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-5653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-261-0900
Provider Business Mailing Address Fax Number:
718-261-0944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10816 72ND AVENUE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-5656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-261-0900
Provider Business Practice Location Address Fax Number:
718-261-0944
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIDOFF
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-261-0900

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  229243 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02990382 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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