Healthcare Provider Details

I. General information

NPI: 1407995541
Provider Name (Legal Business Name): BROOKLYN GASTROENTEROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E 14TH ST
BROOKLYN NY
11229-1104
US

IV. Provider business mailing address

1630 E 14TH ST
BROOKLYN NY
11229-1104
US

V. Phone/Fax

Practice location:
  • Phone: 718-339-0391
  • Fax: 718-339-6923
Mailing address:
  • Phone: 718-339-0391
  • Fax: 718-339-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY GETTENBERG
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-339-0391