Basic Information
| Provider Information | |||||||||
| NPI: | 1720639388 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VANGUARD GASTROENTEROLOGY LLP | ||||||||
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| Address1: | 232 E 30TH ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100168202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127256768 | ||||||||
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| Address1: | 233 BROADWAY RM 2750 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 102792704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128895544 | ||||||||
| FaxNumber: | 2124811089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2019 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | YAKUTILOVA | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6465466263 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
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.