Provider Demographics
NPI:1730120536
Name:GASTROENTEROLOGY CONSULTANTS OF LONG ISLAND, PC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF LONG ISLAND, PC
Other - Org Name:JOHN M COSTABLE MD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COSTABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-673-4801
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE E240
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2061
Mailing Address - Country:US
Mailing Address - Phone:516-673-4801
Mailing Address - Fax:516-352-3680
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE E240
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2061
Practice Address - Country:US
Practice Address - Phone:516-673-4801
Practice Address - Fax:516-352-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEY741Medicare ID - Type Unspecified