Provider Demographics
NPI:1114951126
Name:SOUND SHORE GASTROENTEROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUND SHORE GASTROENTEROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-253-9252
Mailing Address - Street 1:18 RYE RIDGE PLAZA
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573
Mailing Address - Country:US
Mailing Address - Phone:914-253-9252
Mailing Address - Fax:
Practice Address - Street 1:18 RYE RIDGE PLAZA
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-253-9252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTDA8846OtherRAILROAD MEDICARE
NYDB4485OtherDB4485
CTC02992OtherMEDICARE
NYDB4485OtherDB4485