Provider Demographics
NPI:1831324532
Name:ADVANCED GASTROENTEROLOGY AND ENDOSCOPY, P.C.
Entity Type:Organization
Organization Name:ADVANCED GASTROENTEROLOGY AND ENDOSCOPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:S
Authorized Official - Last Name:KARAKURUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-479-3744
Mailing Address - Street 1:70 N COUNTRY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2161
Mailing Address - Country:US
Mailing Address - Phone:631-479-3744
Mailing Address - Fax:561-282-3238
Practice Address - Street 1:70 N COUNTRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2161
Practice Address - Country:US
Practice Address - Phone:631-479-3744
Practice Address - Fax:561-282-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185973207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4V3762OtherEMPIRE BC/BS