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General NPI Number Information
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NPI Number | 1164245080
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Entity Type | Organization
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Legal Business Name | NEW YORK MEDICINE GASTROENTEROLOGY PLLC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 2900 HEMPSTEAD TPKE STE 203
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City | LEVITTOWN
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State | NY
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Zip | 11756-1401
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Country | US
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Telephone | 917-238-8415
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 HEMPSTEAD TPKE STE 203
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City | LEVITTOWN
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State | NY
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Zip | 11756-1401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MITANSHU SHAH
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Credential | MD
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Telephone | 516-884-3032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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