Provider Demographics
NPI:1720639388
Name:VANGUARD GASTROENTEROLOGY LLP
Entity Type:Organization
Organization Name:VANGUARD GASTROENTEROLOGY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUTILOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-889-5544
Mailing Address - Street 1:232 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8202
Mailing Address - Country:US
Mailing Address - Phone:212-725-6768
Mailing Address - Fax:
Practice Address - Street 1:233 BROADWAY RM 2750
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10279-2704
Practice Address - Country:US
Practice Address - Phone:212-889-5544
Practice Address - Fax:212-481-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty