Provider Demographics
NPI:1083962948
Name:ADVANCED AMBULATORY ENDOSCOPY PLLC
Entity Type:Organization
Organization Name:ADVANCED AMBULATORY ENDOSCOPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-535-7908
Mailing Address - Street 1:86 BOWERY
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4615
Mailing Address - Country:US
Mailing Address - Phone:212-775-8388
Mailing Address - Fax:212-775-8383
Practice Address - Street 1:86 BOWERY
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4615
Practice Address - Country:US
Practice Address - Phone:212-775-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical