Provider Demographics
NPI:1952845018
Name:EW GASTRO C.S.P
Entity Type:Organization
Organization Name:EW GASTRO C.S.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WARRINGTON COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-214-9163
Mailing Address - Street 1:LF 1 CALLE 32
Mailing Address - Street 2:URB VILLA DEL REY 5TA SECCION
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-214-9163
Mailing Address - Fax:787-761-5764
Practice Address - Street 1:URB CAUTIVA, 3 ALMACIGOS
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:UM
Practice Address - Phone:787-214-9163
Practice Address - Fax:787-761-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17848207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17848OtherPROF. MEDICAL LIC
PRHU663AMedicare UPIN