Provider Demographics
NPI:1821427964
Name:GASTROENTEROLOGY ASSOCIATES OF BROOKLYN PLLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF BROOKLYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-336-3900
Mailing Address - Street 1:1723 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1069
Mailing Address - Country:US
Mailing Address - Phone:718-336-3900
Mailing Address - Fax:718-336-3990
Practice Address - Street 1:1723 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1069
Practice Address - Country:US
Practice Address - Phone:718-336-3900
Practice Address - Fax:718-336-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty