Provider Demographics
NPI:1407178759
Name:GRAMERCY PARK GASTROENTEROLOGY PC
Entity Type:Organization
Organization Name:GRAMERCY PARK GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:OTTAVIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-845-9255
Mailing Address - Street 1:303 5TH AVE
Mailing Address - Street 2:SUITE #1205
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6601
Mailing Address - Country:US
Mailing Address - Phone:212-845-9255
Mailing Address - Fax:347-602-4674
Practice Address - Street 1:60 GRAMERCY PARK N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5423
Practice Address - Country:US
Practice Address - Phone:212-845-9255
Practice Address - Fax:347-602-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100027197Medicare PIN
NYA400027196Medicare PIN