Healthcare Provider Details

I. General information

NPI: 1538816624
Provider Name (Legal Business Name): BAY RIDGE GASTROENTEROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
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: 718-745-0623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANILA HOXHA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 718-745-0623