Provider Demographics
NPI:1174029953
Name:SPRINGFIELD GARDENS ENDOSCOPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SPRINGFIELD GARDENS ENDOSCOPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMAAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-672-2824
Mailing Address - Street 1:15 LEONELLO LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-2412
Mailing Address - Country:US
Mailing Address - Phone:718-672-2824
Mailing Address - Fax:718-672-4251
Practice Address - Street 1:13421 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1448
Practice Address - Country:US
Practice Address - Phone:718-672-2824
Practice Address - Fax:718-672-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty