Provider Demographics
NPI:1376583641
Name:GASTROENTEROLOGY ASSOCIATES OF NORTHERN NEW YORK PC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF NORTHERN NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERLIHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-793-5034
Mailing Address - Street 1:5 IRONGATE CENTER
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-793-5034
Mailing Address - Fax:518-793-2951
Practice Address - Street 1:5 IRONGATE CENTER
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-793-5034
Practice Address - Fax:518-793-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51661AMedicare ID - Type Unspecified