Provider Demographics
NPI:1003188764
Name:YITZHAK D. TWERSKY M.D., P.C.
Entity Type:Organization
Organization Name:YITZHAK D. TWERSKY M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YITZHAK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TWERSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-476-7710
Mailing Address - Street 1:290 CENTRAL AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-8507
Mailing Address - Country:US
Mailing Address - Phone:516-476-7710
Mailing Address - Fax:516-239-6866
Practice Address - Street 1:290 CENTRAL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-8507
Practice Address - Country:US
Practice Address - Phone:516-476-7710
Practice Address - Fax:516-239-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172791207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE74728Medicare UPIN