Basic Information
| Provider Information | |||||||||
| NPI: | 1538307616 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BINGHAMTON GASTROENTEROLOGY ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 MITCHELL AVE | ||||||||
| Address2: | 3 RD FLOOR | ||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139031678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077720639 | ||||||||
| FaxNumber: | 6077224610 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 MITCHELL AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139031678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077720639 | ||||||||
| FaxNumber: | 6077224610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2009 | ||||||||
| LastUpdateDate: | 07/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCAGNELLI | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6077726919 | ||||||||
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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 | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.