Provider Demographics
NPI:1639261407
Name:ENDO GROUP, LLC
Entity Type:Organization
Organization Name:ENDO GROUP, LLC
Other - Org Name:GARDEN CITY SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
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
Mailing Address - Country:US
Mailing Address - Phone:516-832-8504
Mailing Address - Fax:516-832-1085
Practice Address - Street 1:400 ENDO BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-832-8504
Practice Address - Fax:516-832-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2905200R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331007OtherHIP PROVIDER ID
NY14404OtherAETNA PROVIDER ID
NY01088980Medicaid
NYIC0199OtherHEALTHNET PROVIDER ID
NY003602OtherEMPIRE BCBS PROVIDER ID
NY33C0001007OtherMEDICARE
NYA382712OtherOXFORD PROVIDER ID