Provider Demographics
NPI:1083178651
Name:THE GASTROENTEROLOGY PRACTICE PLLC
Entity Type:Organization
Organization Name:THE GASTROENTEROLOGY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MITANSHU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-884-3032
Mailing Address - Street 1:6 PERRY CT
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2837
Mailing Address - Country:US
Mailing Address - Phone:516-884-3032
Mailing Address - Fax:
Practice Address - Street 1:75 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4028
Practice Address - Country:US
Practice Address - Phone:516-884-3032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty