Healthcare Provider Details

I. General information

NPI: 1336258128
Provider Name (Legal Business Name): NEW YORK GI CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL SUITE M117
BRONX NY
10461-2728
US

IV. Provider business mailing address

1200 WATERS PL SUITE M117
BRONX NY
10461-2728
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-0575
  • Fax: 718-863-2467
Mailing address:
  • Phone: 718-863-0575
  • Fax: 718-863-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES COSTABILE DILORENZO
Title or Position: DIRECTOR
Credential: MD
Phone: 914-725-9115