Provider Demographics
NPI:1336355718
Name:GASTROENTEROLOGY SPECIALIST INC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERRAMILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-630-8775
Mailing Address - Street 1:3355 BURNS RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4353
Mailing Address - Country:US
Mailing Address - Phone:561-630-8775
Mailing Address - Fax:561-630-2892
Practice Address - Street 1:3355 BURNS RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4353
Practice Address - Country:US
Practice Address - Phone:561-630-8775
Practice Address - Fax:561-630-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6088Medicare ID - Type Unspecified