Provider Demographics
NPI:1629106885
Name:DIGESTIVE HEALTH MEDICAL ASSOC. PC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH MEDICAL ASSOC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BRONZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-466-5166
Mailing Address - Street 1:114 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2320
Mailing Address - Country:US
Mailing Address - Phone:516-741-7769
Mailing Address - Fax:516-877-2012
Practice Address - Street 1:114 BIRCH DR
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2320
Practice Address - Country:US
Practice Address - Phone:516-741-7769
Practice Address - Fax:516-877-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131009207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC10152Medicare UPIN
NYW32401Medicare PIN