Healthcare Provider Details

I. General information

NPI: 1134868045
Provider Name (Legal Business Name): NEWTOWN GASTROENTEROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8710 51ST AVE
ELMHURST NY
11373-3908
US

IV. Provider business mailing address

8710 51ST AVE
ELMHURST NY
11373-3908
US

V. Phone/Fax

Practice location:
  • Phone: 917-398-2588
  • Fax:
Mailing address:
  • Phone: 917-398-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KEVIN TIN
Title or Position: MD
Credential:
Phone: 917-336-8422