Provider Demographics
NPI:1366624140
Name:DOUGLASTON ENDOSCOPY OBS PC
Entity Type:Organization
Organization Name:DOUGLASTON ENDOSCOPY OBS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-461-0163
Mailing Address - Street 1:24102 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1061
Mailing Address - Country:US
Mailing Address - Phone:718-461-0163
Mailing Address - Fax:
Practice Address - Street 1:24102 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1061
Practice Address - Country:US
Practice Address - Phone:718-461-0163
Practice Address - Fax:718-358-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy