Basic Information
Provider Information
NPI: 1518984277
EntityType: 2
ReplacementNPI:  
OrganizationName: DIGESTIVE DISEASE CONSULTANTS,INC.
LastName:  
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Mailing Information
Address1: 67 KENDALL ST
Address2: SUITE 200
City: CLIFTON SPRINGS
State: NY
PostalCode: 144329701
CountryCode: US
TelephoneNumber: 3154629482
FaxNumber: 3154625438
Practice Location
Address1: 4 COULTER RD
Address2:  
City: CLIFTON SPRINGS
State: NY
PostalCode: 144321122
CountryCode: US
TelephoneNumber: 3154621374
FaxNumber: 3154626707
Other Information
ProviderEnumerationDate: 07/17/2006
LastUpdateDate: 08/18/2008
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: BIERY
AuthorizedOfficialFirstName: DANIEL
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 3154621374
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DO
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0008X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
207RG0100X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

ID Information
IDTypeStateIssuerDescription
0267694205NY MEDICAID


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