Provider Demographics
NPI:1598328932
Name:ENDO GROUP, LLC
Entity Type:Organization
Organization Name:ENDO GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BINI
Authorized Official - Middle Name:
Authorized Official - Last Name:VARUGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-832-8504
Mailing Address - Street 1:400 ENDO BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-6723
Mailing Address - Country:US
Mailing Address - Phone:516-832-8504
Mailing Address - Fax:
Practice Address - Street 1:240 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4504
Practice Address - Country:US
Practice Address - Phone:516-517-5300
Practice Address - Fax:516-730-2305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENDO GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical