Provider Demographics
NPI:1275654055
Name:SHEEPSHEAD BAY ENDOSCOPY LLC
Entity Type:Organization
Organization Name:SHEEPSHEAD BAY ENDOSCOPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-368-2960
Mailing Address - Street 1:2211 EMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2792
Mailing Address - Country:US
Mailing Address - Phone:516-316-0830
Mailing Address - Fax:
Practice Address - Street 1:2211 EMMONS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2792
Practice Address - Country:US
Practice Address - Phone:516-316-0830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy