Provider Demographics
NPI:1043202641
Name:GASTROENTEROLOGY & HEPATOLOGY OF CENTRAL NEW YORK, PC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY & HEPATOLOGY OF CENTRAL NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-452-3235
Mailing Address - Street 1:5112 W TAFT RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-452-3235
Mailing Address - Fax:315-452-5627
Practice Address - Street 1:5112 W TAFT RD
Practice Address - Street 2:SUITE H
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4868
Practice Address - Country:US
Practice Address - Phone:315-452-3235
Practice Address - Fax:315-452-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02589999Medicaid
55986AMedicare ID - Type Unspecified