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General NPI Number Information
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NPI Number | 1194768366
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Entity Type | Organization
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Legal Business Name | LONG ISLAND GASTROENTEROLOGY GROUP P C
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 09/18/2013
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Provider Practice Location Address
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Address Line | 131 MERRICK RD
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City | MERRICK
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State | NY
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Zip | 11566-4542
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Country | US
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Telephone | 516-223-1515
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Fax | 516-223-8205
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Provider Business Mailing Address
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Address Line | 131 MERRICK RD
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City | MERRICK
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State | NY
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Zip | 11566-4542
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Country | US
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Telephone | 516-223-1515
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Fax | 516-223-8205
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD STELLER
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Credential | MD
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Telephone | 516-223-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 241064
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 129485
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License Number State | NY
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