Basic Information
| Provider Information | |||||||||
| NPI: | 1093034688 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JKAN GASTROENTEROLOGY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 BROADWAY STE 1800 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100061652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123881062 | ||||||||
| FaxNumber: | 2123881063 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 BROADWAY STE 1800 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123881062 | ||||||||
| FaxNumber: | 2123881063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2010 | ||||||||
| LastUpdateDate: | 03/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | LAU | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9176077488 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 197142 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 776098P | 01 | NY | HIP | OTHER | 90R211 | 01 | NY | EMPIRE BC BS | OTHER | 6823925 | 01 | NY | CIGNA | OTHER | 2468205 | 01 | NY | UNITEDHEALTHCARE | OTHER | 1338113 | 01 | NY | GHI | OTHER | 7C4921 | 01 | NY | HEALTHNET | OTHER | P4130574 | 01 | NY | OXFORD | OTHER | 7193492 | 01 | NY | AETNA | OTHER |