Provider Demographics
NPI:1235580218
Name:THG ROOSEVELT ENDOSCOPY PC
Entity Type:Organization
Organization Name:THG ROOSEVELT ENDOSCOPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONG
Authorized Official - Middle Name:
Authorized Official - Last Name:JING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-886-9819
Mailing Address - Street 1:15 OAK DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1809
Mailing Address - Country:US
Mailing Address - Phone:718-886-9819
Mailing Address - Fax:
Practice Address - Street 1:13668 ROOSEVELT AVE FL 3
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5510
Practice Address - Country:US
Practice Address - Phone:718-886-9819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256797207L00000X, 207R00000X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty