Provider Demographics
NPI:1518110923
Name:PREMIER ENDOSCOPY SUITES PC
Entity Type:Organization
Organization Name:PREMIER ENDOSCOPY SUITES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:BANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-437-6900
Mailing Address - Street 1:3620 E TREMONT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2038
Mailing Address - Country:US
Mailing Address - Phone:718-409-2902
Mailing Address - Fax:718-409-2919
Practice Address - Street 1:2 POLO DR
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1043
Practice Address - Country:US
Practice Address - Phone:516-437-6900
Practice Address - Fax:516-437-6904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy