Healthcare Provider Details

I. General information

NPI: 1245313709
Provider Name (Legal Business Name): HARRY G DEMEO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 4TH AVE STE 205
BROOKLYN NY
11209-8328
US

IV. Provider business mailing address

9920 4TH AVE STE 205
BROOKLYN NY
11209-8328
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number159760
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: