Provider Demographics
NPI:1841608601
Name:FIVE TOWNS GASTROENTEROLOGY
Entity Type:Organization
Organization Name:FIVE TOWNS GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FENSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-374-0670
Mailing Address - Street 1:657 CENTRAL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2320
Mailing Address - Country:US
Mailing Address - Phone:516-374-0670
Mailing Address - Fax:516-569-7140
Practice Address - Street 1:657 CENTRAL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2320
Practice Address - Country:US
Practice Address - Phone:516-374-0670
Practice Address - Fax:516-569-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100158482Medicare PIN
NYA100107305Medicare PIN