Provider Demographics
NPI:1275846818
Name:NEW HYDE PARK GASTROENTEROLOGY PC
Entity Type:Organization
Organization Name:NEW HYDE PARK GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANT
Authorized Official - Middle Name:VIJAY
Authorized Official - Last Name:INDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-358-7210
Mailing Address - Street 1:1575 HILLSIDE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1575 HILLSIDE AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2501
Practice Address - Country:US
Practice Address - Phone:516-358-7210
Practice Address - Fax:516-352-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-25
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty