Provider Demographics
NPI:1073626495
Name:WESTERN SUFFOLK GASTROENTEROLOGY ASSOC LLP
Entity Type:Organization
Organization Name:WESTERN SUFFOLK GASTROENTEROLOGY ASSOC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:ASHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-968-8288
Mailing Address - Street 1:375 E MAIN ST
Mailing Address - Street 2:STE 21
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-968-8288
Mailing Address - Fax:631-968-8268
Practice Address - Street 1:375 E MAIN ST
Practice Address - Street 2:STE 21
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-968-8288
Practice Address - Fax:631-968-8268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W85701Medicare ID - Type Unspecified