Provider Demographics
NPI:1093034688
Name:JKAN GASTROENTEROLOGY PLLC
Entity Type:Organization
Organization Name:JKAN GASTROENTEROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-607-7488
Mailing Address - Street 1:115 BROADWAY STE 1800
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1652
Mailing Address - Country:US
Mailing Address - Phone:212-388-1062
Mailing Address - Fax:212-388-1063
Practice Address - Street 1:115 BROADWAY STE 1800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006
Practice Address - Country:US
Practice Address - Phone:212-388-1062
Practice Address - Fax:212-388-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-22
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197142207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY776098POtherHIP
NY90R211OtherEMPIRE BC BS
NY6823925OtherCIGNA
NY2468205OtherUNITEDHEALTHCARE
NY1338113OtherGHI
NY7C4921OtherHEALTHNET
NYP4130574OtherOXFORD
NY7193492OtherAETNA