Provider Demographics
NPI:1164509287
Name:NORTHEAST GASTROENTEROLOGY CENTER, INC.
Entity Type:Organization
Organization Name:NORTHEAST GASTROENTEROLOGY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:KUL
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-454-1400
Mailing Address - Street 1:10 PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-9394
Mailing Address - Country:US
Mailing Address - Phone:570-454-1400
Mailing Address - Fax:570-454-2144
Practice Address - Street 1:10 PARK PL
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-2885
Practice Address - Country:US
Practice Address - Phone:570-454-1400
Practice Address - Fax:570-454-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA513306OtherAETNA
PAP006599OtherTRICARE
PA0016044280008Medicaid
PAP006599OtherTRICARE