Healthcare Provider Details

I. General information

NPI: 1376750026
Provider Name (Legal Business Name): GASTROINTESTINAL AND LIVER DISEASE SPECIALISTS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 BAY RIDGE PKWY
BROOKLYN NY
11209-3310
US

IV. Provider business mailing address

560 BAY RIDGE PKWY
BROOKLYN NY
11209-3310
US

V. Phone/Fax

Practice location:
  • Phone: 718-748-5219
  • Fax: 718-748-3793
Mailing address:
  • Phone: 718-748-5219
  • Fax: 718-748-3793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name: MRS. LINA KUSHNIR
Title or Position: OFFICE MANAGER
Credential:
Phone: 718-748-5219