Healthcare Provider Details

I. General information

NPI: 1427256585
Provider Name (Legal Business Name): BRONX GASTROENTEROLOGY OBS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 WILLIAMSBRIDGE RD
BRONX NY
10461-6206
US

IV. Provider business mailing address

1842 WILLIAMSBRIDGE RD
BRONX NY
10461-6206
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-0100
  • Fax: 718-828-0586
Mailing address:
  • Phone: 718-828-0100
  • Fax: 718-828-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEIL HERBSMAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 718-828-0100