Provider Demographics
NPI:1356606743
Name:SRI GASTROENTEROLOGY PC
Entity type:Organization
Organization Name:SRI GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-416-4389
Mailing Address - Street 1:8 QUAKER LN
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1320
Mailing Address - Country:US
Mailing Address - Phone:718-416-4389
Mailing Address - Fax:718-416-3652
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-222-2727
Practice Address - Fax:718-416-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA1000075759OtherMEDICARE PTAN
NYA400075761OtherMEDICARE PTAN OTHER
NYA1000075759Medicare PIN