Basic Information
| Provider Information | |||||||||
| NPI: | 1710196738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER NEW YORK GASTROENTEROLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 137 5TH AVE | ||||||||
| Address2: | 7TH FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100107103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122532118 | ||||||||
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| Address1: | 137 5TH AVE | ||||||||
| Address2: | 7TH FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100107103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122532118 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 06/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | ENG | ||||||||
| AuthorizedOfficialFirstName: | HON-MING | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2122532118 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 198126-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 02137800 | 05 | NY | MEDICAID |