Healthcare Provider Details

I. General information

NPI: 1861658908
Provider Name (Legal Business Name): SHEEPSHEAD BAY ENDOSCOPY AND ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 EMMONS AVE
BROOKLYN NY
11235-2792
US

IV. Provider business mailing address

2211 EMMONS AVE
BROOKLYN NY
11235-2792
US

V. Phone/Fax

Practice location:
  • Phone: 718-368-2960
  • Fax: 718-368-2249
Mailing address:
  • Phone: 718-368-2960
  • Fax: 718-368-2249

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. SCOTT MITCHEL TENNER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 718-368-2960