MEDICARE: NEW YORK DIGESTIVE DISEASE CENTER ,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1184485666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK DIGESTIVE DISEASE CENTER ,LLC

Provider Business Mailing Address
First Line	:	5514 MAIN ST STE 2B
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5005
Country	:	US
Telephone Number	:	718-321-0670
Fax Number	:	718-321-0099

Provider Business Practice Location Address
First Line	:	5514 MAIN ST STE 2B
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5005
Country	:	US
Telephone Number	:	718-321-0670
Fax Number	:	718-321-0099

Authorized Official
Title or Position	:	OWNER
Name	:	KAUMUDI SOMNAY
Credential	:	MD
Telephone Number	:	718-321-0670

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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