Basic Information
Provider Information | |||||||||
NPI: | 1700382736 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | GASTROENTEROLOGY ASSOCIATES OF FLORIDA LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5401 S CONGRESS AVE STE 211 | ||||||||
Address2: |   | ||||||||
City: | ATLANTIS | ||||||||
State: | FL | ||||||||
PostalCode: | 334626637 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5619648221 | ||||||||
FaxNumber: | 5619647393 | ||||||||
Practice Location | |||||||||
Address1: | 5401 S CONGRESS AVE STE 211 | ||||||||
Address2: |   | ||||||||
City: | ATLANTIS | ||||||||
State: | FL | ||||||||
PostalCode: | 334626637 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5619648221 | ||||||||
FaxNumber: | 5619647393 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/30/2018 | ||||||||
LastUpdateDate: | 01/14/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | STEINBERG | ||||||||
AuthorizedOfficialFirstName: | SETH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
AuthorizedOfficialTelephone: | 5619648221 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: | 01/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
ID | Type | State | Issuer | Description | S351797620950 | 01 | FL | FLORIDA DRIVERS LICENSE | OTHER |