Healthcare Provider Details

I. General information

NPI: 1063465037
Provider Name (Legal Business Name): TWIN RIVERS ENDOSCOPY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COMMUNITY DR
EASTON PA
18045-2658
US

IV. Provider business mailing address

20 COMMUNITY DR
EASTON PA
18045-2658
US

V. Phone/Fax

Practice location:
  • Phone: 610-258-6635
  • Fax: 610-258-2879
Mailing address:
  • Phone: 610-258-6635
  • Fax: 610-258-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number05711500
License Number StatePA

VIII. Authorized Official

Name: DR. SHANKER MUKHERJEE
Title or Position: CEO
Credential: M.D.
Phone: 610-258-6635