Healthcare Provider Details

I. General information

NPI: 1659827285
Provider Name (Legal Business Name): DIGESTIVE CARE AND ENDOSCOPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10816 72ND AVENUE 2ND FLOOR
FOREST HILLS NY
11375-5656
US

IV. Provider business mailing address

10816 72ND AVE 2ND FLOOR
FOREST HILLS NY
11375-5653
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-0900
  • Fax: 718-261-0944
Mailing address:
  • Phone: 718-261-0900
  • Fax: 718-261-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number229243
License Number StateNY

VIII. Authorized Official

Name: DR. SAMUEL DAVIDOFF
Title or Position: PRESIDENT
Credential: MD
Phone: 718-261-0900