Healthcare Provider Details

I. General information

NPI: 1144322801
Provider Name (Legal Business Name): HARRY SNADY MD PHD, FACG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 KENNEDY BLVD W SUITE 103
WEST NEW YORK NJ
07093-1256
US

IV. Provider business mailing address

22 EAST 88TH STREET ADMINISTRATIVE AND PRIMARY OFFICE
NEW YORK NY
10128
US

V. Phone/Fax

Practice location:
  • Phone: 201-902-9500
  • Fax: 201-902-9502
Mailing address:
  • Phone: 212-831-0700
  • Fax: 212-410-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number135601-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA03842900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: