Provider Demographics
NPI:1780792119
Name:ATLANTIC GASTROENTEROLOGY, P.C.
Entity type:Organization
Organization Name:ATLANTIC GASTROENTEROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-615-4001
Mailing Address - Street 1:2797 OCEAN PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7868
Mailing Address - Country:US
Mailing Address - Phone:718-615-4001
Mailing Address - Fax:718-615-4004
Practice Address - Street 1:2797 OCEAN PKWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7861
Practice Address - Country:US
Practice Address - Phone:718-615-4001
Practice Address - Fax:718-615-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239090207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03140030Medicaid