=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063465037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TWIN RIVERS ENDOSCOPY CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 COMMUNITY DR
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18045-2658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-258-6635
-----------------------------------------------------
Fax | 610-258-2879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 COMMUNITY DR
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18045-2658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-258-6635
-----------------------------------------------------
Fax | 610-258-2879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. SHANKER MUKHERJEE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 610-258-6635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0800X
-----------------------------------------------------
Taxonomy Name | Endoscopy Clinic/Center
-----------------------------------------------------
License Number | 05711500
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------