Provider Demographics
NPI:1558375584
Name:GREATER NEW YORK GASTROENTEROLOGY, LLP
Entity Type:Organization
Organization Name:GREATER NEW YORK GASTROENTEROLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:KLINGENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-626-2337
Mailing Address - Street 1:2325 31ST ST STE 500
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2299
Mailing Address - Country:US
Mailing Address - Phone:718-626-2337
Mailing Address - Fax:718-626-7655
Practice Address - Street 1:2325 31ST ST STE 500
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2299
Practice Address - Country:US
Practice Address - Phone:718-626-2337
Practice Address - Fax:718-626-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134287207R00000X, 207RG0100X
NY183504207R00000X, 207RG0100X
NY208960207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02167173Medicaid
NY01366985Medicaid
NY00617905Medicaid
NY02167173Medicaid
NYF26530Medicare UPIN
NY01366985Medicaid
NYB88588Medicare UPIN
NY04512Medicare ID - Type Unspecified
NY00617905Medicaid