Healthcare Provider Details

I. General information

NPI: 1902070832
Provider Name (Legal Business Name): GASTRO OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 MERRICK AVE STE 150N
WESTBURY NY
11590
US

IV. Provider business mailing address

865 MERRICK AVE STE 150N
WESTBURY NY
11590
US

V. Phone/Fax

Practice location:
  • Phone: 516-542-3636
  • Fax: 516-222-8212
Mailing address:
  • Phone: 516-542-3636
  • Fax: 516-222-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number061004
License Number StateNY

VIII. Authorized Official

Name: JENNIFER B. BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954