Provider Demographics
NPI:1508052846
Name:GASTROENTEROLOGY AND LIVER DISEASE OF THE BRONX, P.C.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY AND LIVER DISEASE OF THE BRONX, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:I
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-879-6600
Mailing Address - Street 1:1180 MORRIS PARK AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1925
Mailing Address - Country:US
Mailing Address - Phone:718-879-6600
Mailing Address - Fax:718-892-6594
Practice Address - Street 1:1180 MORRIS PARK AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1925
Practice Address - Country:US
Practice Address - Phone:718-879-6600
Practice Address - Fax:718-892-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEIN