Provider Demographics
NPI:1821673286
Name:EAST END GASTROENTEROLOGY PLLC
Entity Type:Organization
Organization Name:EAST END GASTROENTEROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORONEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-591-3000
Mailing Address - Street 1:856 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2540
Mailing Address - Country:US
Mailing Address - Phone:631-591-3000
Mailing Address - Fax:631-591-1734
Practice Address - Street 1:287 WADING RIVER RD
Practice Address - Street 2:UNIT 2
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3383
Practice Address - Country:US
Practice Address - Phone:631-591-3000
Practice Address - Fax:631-591-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty