Provider Demographics
NPI:1376940072
Name:EMPIRE STATE COLON & RECTAL SURGERY, LLC
Entity Type:Organization
Organization Name:EMPIRE STATE COLON & RECTAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HANS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURKHOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-676-2449
Mailing Address - Street 1:1928 BAY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6214
Mailing Address - Country:US
Mailing Address - Phone:718-676-2449
Mailing Address - Fax:718-676-2450
Practice Address - Street 1:1928 BAY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6214
Practice Address - Country:US
Practice Address - Phone:718-676-2449
Practice Address - Fax:718-676-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275077208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty