Healthcare Provider Details

I. General information

NPI: 1558375584
Provider Name (Legal Business Name): GREATER NEW YORK GASTROENTEROLOGY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 31ST ST STE 500
ASTORIA NY
11105-2299
US

IV. Provider business mailing address

2325 31ST ST STE 500
ASTORIA NY
11105-2299
US

V. Phone/Fax

Practice location:
  • Phone: 718-626-2337
  • Fax: 718-626-7655
Mailing address:
  • Phone: 718-626-2337
  • Fax: 718-626-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number134287
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number183504
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number208960
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number134287
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number183504
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number208960
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY KENNETH KLINGENSTEIN
Title or Position: OFFICER
Credential: MD
Phone: 718-626-2337