Healthcare Provider Details

I. General information

NPI: 1356606743
Provider Name (Legal Business Name): SRI GASTROENTEROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 STEWART AVE
GARDEN CITY NY
11530-4893
US

IV. Provider business mailing address

8 QUAKER LN
OLD WESTBURY NY
11568-1320
US

V. Phone/Fax

Practice location:
  • Phone: 516-222-2727
  • Fax: 718-416-3652
Mailing address:
  • Phone: 718-416-4389
  • Fax: 718-416-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SRIDEVI BHUMI
Title or Position: PHYSICIAN
Credential: MD
Phone: 718-416-4389