Healthcare Provider Details

I. General information

NPI: 1518459569
Provider Name (Legal Business Name): EAST COAST GASTROENTEROLOGY AND ENDOSCOPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 N OCEAN AVE
PATCHOGUE NY
11772-2018
US

IV. Provider business mailing address

153 N OCEAN AVE
PATCHOGUE NY
11772-2018
US

V. Phone/Fax

Practice location:
  • Phone: 631-714-4444
  • Fax: 631-605-7373
Mailing address:
  • Phone: 631-714-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number270874
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier270874
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENSE

VIII. Authorized Official

Name: CHRISTOPHER TOMAINO
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 631-714-4444