Provider Demographics
NPI:1245479450
Name:DLD ENDOSCOPY PLLC
Entity type:Organization
Organization Name:DLD ENDOSCOPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVYANG
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-876-9600
Mailing Address - Street 1:5 LITTLE CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4304
Mailing Address - Country:US
Mailing Address - Phone:718-876-9600
Mailing Address - Fax:718-876-7738
Practice Address - Street 1:5 LITTLE CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4304
Practice Address - Country:US
Practice Address - Phone:718-876-9600
Practice Address - Fax:718-876-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
157047-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00994990Medicaid
87D341Medicare UPIN