MEDICARE: PREMIER ENDOSCOPY SUITES PC

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	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1932644531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ENDOSCOPY SUITES PC

Provider Business Mailing Address
First Line	:	3620 E TREMONT AVE
Second Line	:	SUITE 104
City	:	BRONX
State	:	NY
Zip	:	10465-2038
Country	:	US
Telephone Number	:	718-409-2902
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 E TREMONT AVE
Second Line	:	SUITE 104
City	:	BRONX
State	:	NY
Zip	:	10465-2038
Country	:	US
Telephone Number	:	718-409-2902
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAJIV BANSAL
Credential	:	M.D.
Telephone Number	:	718-409-2902

Provider Enumeration Date	:	01/05/2017
Last Update Date	:	01/05/2017

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