Provider Demographics
NPI:1992357248
Name:GASTROENTEROLOGY AND HEPATOLOGY FL LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY AND HEPATOLOGY FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-226-0284
Mailing Address - Street 1:9534 WICKHAM WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5524
Mailing Address - Country:US
Mailing Address - Phone:917-226-0284
Mailing Address - Fax:
Practice Address - Street 1:6735 CONROY RD STE 223
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3570
Practice Address - Country:US
Practice Address - Phone:917-226-0284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant HepatologyGroup - Multi-Specialty