Healthcare Provider Details

I. General information

NPI: 1518984277
Provider Name (Legal Business Name): DIGESTIVE DISEASE CONSULTANTS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COULTER RD
CLIFTON SPRINGS NY
14432-1122
US

IV. Provider business mailing address

67 KENDALL ST SUITE 200
CLIFTON SPRINGS NY
14432-9701
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-1374
  • Fax: 315-462-6707
Mailing address:
  • Phone: 315-462-9482
  • Fax: 315-462-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL L BIERY
Title or Position: OWNER
Credential: DO
Phone: 315-462-1374