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NPI Code Detail

MEDICARE: SHEEPSHEAD BAY ENDOSCOPY AND ASSOCIATES, PLLC

MEDICARE: SHEEPSHEAD BAY ENDOSCOPY AND ASSOCIATES, PLLC
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
1207RG0100XGastroenterology Physician

General Provider Information

NPI Number : 1861658908
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHEEPSHEAD BAY ENDOSCOPY AND ASSOCIATES, PLLC
Provider Business Mailing Address
First Line : 2211 EMMONS AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-2792
Country : US
Telephone Number : 718-368-2960
Fax Number : 718-368-2249
Provider Business Practice Location Address
First Line : 2211 EMMONS AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-2792
Country : US
Telephone Number : 718-368-2960
Fax Number : 718-368-2249
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. SCOTT MITCHEL TENNER
Credential : M.D.
Telephone Number : 718-368-2960
Provider Enumeration Date : 07/29/2008
Last Update Date : 10/07/2008

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Practice Location Address:
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Practice Location Address:
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