Provider Demographics
NPI:1861662991
Name:BROOKLYN GASTROENTEROLOGY AND ENDOSCOPY PLLC
Entity Type:Organization
Organization Name:BROOKLYN GASTROENTEROLOGY AND ENDOSCOPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-368-2960
Mailing Address - Street 1:2211 EMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2792
Mailing Address - Country:US
Mailing Address - Phone:718-368-2960
Mailing Address - Fax:718-368-2249
Practice Address - Street 1:2211 EMMONS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2792
Practice Address - Country:US
Practice Address - Phone:718-368-2960
Practice Address - Fax:718-368-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1Other1