Provider Demographics
NPI:1881610426
Name:PALMADESSA & BRODSKY GASTROENTEROLOGY ASSOCIATES P.C.
Entity type:Organization
Organization Name:PALMADESSA & BRODSKY GASTROENTEROLOGY ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALMADESSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-461-0163
Mailing Address - Street 1:241-02 NORTHERN BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1060
Mailing Address - Country:US
Mailing Address - Phone:718-461-0163
Mailing Address - Fax:718-358-5570
Practice Address - Street 1:241-02 NORTHERN BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1060
Practice Address - Country:US
Practice Address - Phone:718-461-0163
Practice Address - Fax:718-358-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02584578Medicaid
NY00847576Medicaid
NY00771IMedicare ID - Type UnspecifiedNEIL BRODSKY
NYG17347Medicare UPIN
NY02584578Medicaid
NY00847576Medicaid