Basic Information
| Provider Information | |||||||||
| NPI: | 1275846818 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW HYDE PARK GASTROENTEROLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1575 HILLSIDE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110402501 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1575 HILLSIDE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110402501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163587210 | ||||||||
| FaxNumber: | 5163522596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2010 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | INDARAM | ||||||||
| AuthorizedOfficialFirstName: | ANANT | ||||||||
| AuthorizedOfficialMiddleName: | VIJAY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5163587210 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.