Provider Demographics
NPI:1356428387
Name:NEW YORK GASTROENTEROLOGY ASSOCIATES LLP
Entity type:Organization
Organization Name:NEW YORK GASTROENTEROLOGY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-639-8827
Mailing Address - Street 1:PO BOX 780217
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-0217
Mailing Address - Country:US
Mailing Address - Phone:718-639-8827
Mailing Address - Fax:718-639-8811
Practice Address - Street 1:311 E 79TH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0903
Practice Address - Country:US
Practice Address - Phone:212-996-6633
Practice Address - Fax:212-996-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID NUMBER
NYW34041Medicare PIN