Provider Demographics
NPI:1659827285
Name:DIGESTIVE CARE AND ENDOSCOPY, PLLC
Entity Type:Organization
Organization Name:DIGESTIVE CARE AND ENDOSCOPY, PLLC
Other - Org Name:DIGESTIVE CARE & ENDOSCOPY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-261-0900
Mailing Address - Street 1:10816 72ND AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5653
Mailing Address - Country:US
Mailing Address - Phone:718-261-0900
Mailing Address - Fax:718-261-0944
Practice Address - Street 1:10816 72ND AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5656
Practice Address - Country:US
Practice Address - Phone:718-261-0900
Practice Address - Fax:718-261-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229243173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02990382Medicaid
NYG400000395Medicare PIN