Provider Demographics
NPI:1467492884
Name:GASTROENTEROLOGY MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY MEDICAL GROUP, PC
Other - Org Name:GASTROENTEROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHURANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-471-9410
Mailing Address - Street 1:243 NORTH RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1172
Mailing Address - Country:US
Mailing Address - Phone:845-471-9410
Mailing Address - Fax:845-471-7943
Practice Address - Street 1:243 NORTH RD
Practice Address - Street 2:SUITE 304
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1172
Practice Address - Country:US
Practice Address - Phone:845-471-9410
Practice Address - Fax:845-471-7943
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 Licenses
StateLicense IDTaxonomies
NY143056207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW4L901Medicare ID - Type Unspecified