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General NPI Number Information
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NPI Number | 1184921371
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Entity Type | Organization
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Legal Business Name | ENDOSCOPIC SURGERY OF NY PC
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 10202 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-3197
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Country | US
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Telephone | 718-672-2824
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Fax |
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Provider Business Mailing Address
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Address Line | 10202 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-3197
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Country | US
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Telephone | 718-672-2824
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. ROM GUPTA
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Credential | M.D.
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Telephone | 718-672-2824
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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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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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