Provider Demographics
NPI:1265571863
Name:GASTROINTESTINAL CARE OF LONG ISLAND PLLC
Entity type:Organization
Organization Name:GASTROINTESTINAL CARE OF LONG ISLAND PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RCM OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PFEIFLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:640-333-0304
Mailing Address - Street 1:187 ROUTE 36 STE 230
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1306
Mailing Address - Country:US
Mailing Address - Phone:732-702-1039
Mailing Address - Fax:732-548-7408
Practice Address - Street 1:187 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4982
Practice Address - Country:US
Practice Address - Phone:516-795-5523
Practice Address - Fax:516-795-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151369-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13B76YWVW1OtherMEDICARE PTAN
NYWYWVW1Medicare PIN