Basic Information
| Provider Information | |||||||||
| NPI: | 1831616671 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL PARK GASTROINTESTINAL ENDOSCOPY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 E 68TH ST STE 1E | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100654905 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 E 68TH ST STE 1E | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100654905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125706945 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2017 | ||||||||
| LastUpdateDate: | 08/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | SOLNY | ||||||||
| AuthorizedOfficialFirstName: | MEYER | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2125706945 | ||||||||
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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 | 261QA1903X | 3262 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 3262 | 01 | NY | AMERICAN ASSOCIATION FOR ACCREDITATION OF AMBULATORY FACILITIES, INC. | OTHER |