Provider Demographics
NPI:1881009447
Name:GASTROENTEROLOGY CARE OF LI PC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CARE OF LI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-271-9151
Mailing Address - Street 1:94 GARDINERS AVE
Mailing Address - Street 2:#334
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3705
Mailing Address - Country:US
Mailing Address - Phone:631-271-9151
Mailing Address - Fax:631-271-9155
Practice Address - Street 1:94 GARDINERS AVE
Practice Address - Street 2:#334
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3705
Practice Address - Country:US
Practice Address - Phone:631-271-9151
Practice Address - Fax:631-271-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135237-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY135237-1OtherLICENSE