Healthcare Provider Details

I. General information

NPI: 1043202641
Provider Name (Legal Business Name): GASTROENTEROLOGY & HEPATOLOGY OF CENTRAL NEW YORK, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 W TAFT RD SUITE H
LIVERPOOL NY
13088-4868
US

IV. Provider business mailing address

5112 W TAFT RD SUITE H
LIVERPOOL NY
13088
US

V. Phone/Fax

Practice location:
  • Phone: 315-452-3235
  • Fax: 315-452-5726
Mailing address:
  • Phone: 315-452-3235
  • Fax: 315-452-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS J ROMANO
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 315-452-3235