Provider Demographics
NPI:1073638813
Name:ADVANCED GASTROENTEROLOGY, P.C.
Entity Type:Organization
Organization Name:ADVANCED GASTROENTEROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAROONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-869-5252
Mailing Address - Street 1:5516 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5098
Mailing Address - Country:US
Mailing Address - Phone:718-461-6161
Mailing Address - Fax:718-461-3590
Practice Address - Street 1:5516 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5098
Practice Address - Country:US
Practice Address - Phone:718-461-6161
Practice Address - Fax:718-461-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4C5807OtherHEALTHNET
NY137AB2OtherMANHASSET OFFICE BCBS
NY339161OtherUNITED HEALTHCARE
NY34997491OtherMULTIPLAN
NYAETNAOther3336497
NYHR7144OtherATLANTIS
NY2499224OtherGHI
NY00840588Medicaid
NY10P0702OtherNY PRESBYTERRIAN
NY130000OtherELDERPLAN
NY137144OtherHIP
NY100033916101OtherUHC MEDICAID
NY137AB1OtherFLUSHING OFFICE BCBS
NY40126OtherVYTRA
NY450323OtherHEALTHCARE PARTNERS
NYDP604OtherOXFORD
NY4V3721Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY00840588Medicaid
NY2499224OtherGHI