Provider Demographics
NPI:1609882042
Name:DIGESTIVE DISEASE ASSOCIATES LLP
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:DYTOC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-723-1510
Mailing Address - Street 1:1561 LONG POND RD
Mailing Address - Street 2:STE 110
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626
Mailing Address - Country:US
Mailing Address - Phone:585-723-1510
Mailing Address - Fax:585-723-1518
Practice Address - Street 1:1561 LONG POND RD
Practice Address - Street 2:STE 110
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-723-1510
Practice Address - Fax:585-723-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197367207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01541102Medicaid
NY01541102Medicaid
NY14469BMedicare ID - Type Unspecified