Provider Demographics
NPI:1538307616
Name:BINGHAMTON GASTROENTEROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:BINGHAMTON GASTROENTEROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCAGNELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-772-6919
Mailing Address - Street 1:40 MITCHELL AVE
Mailing Address - Street 2:3 RD FLOOR
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1678
Mailing Address - Country:US
Mailing Address - Phone:607-772-0639
Mailing Address - Fax:607-722-4610
Practice Address - Street 1:40 MITCHELL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1678
Practice Address - Country:US
Practice Address - Phone:607-772-0639
Practice Address - Fax:607-722-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100000217Medicare PIN