Healthcare Provider Details

I. General information

NPI: 1881610426
Provider Name (Legal Business Name): PALMADESSA & BRODSKY GASTROENTEROLOGY ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241-02 NORTHERN BLVD 1ST FLOOR
DOUGLASTON NY
11362-1060
US

IV. Provider business mailing address

241-02 NORTHERN BLVD 1ST FLOOR
DOUGLASTON NY
11362-1060
US

V. Phone/Fax

Practice location:
  • Phone: 718-461-0163
  • Fax: 718-358-5570
Mailing address:
  • Phone: 718-461-0163
  • Fax: 718-358-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DONALD J PALMADESSA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-461-0163