Healthcare Provider Details

I. General information

NPI: 1164516084
Provider Name (Legal Business Name): ENDOSCOPIC AMBULATORY SPECIALTY CENTER OF BAY RIDGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 4TH AVE SUITE 1A
BROOKLYN NY
11209-3207
US

IV. Provider business mailing address

7601 4TH AVE SUITE 1A
BROOKLYN NY
11209-3207
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-0623
  • Fax: 718-745-8091
Mailing address:
  • Phone: 718-745-0623
  • Fax: 718-745-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS ANILA HOXHA
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 718-745-0623