=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265574768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDOSCOPY CENTER OF LONG ISLAND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 01/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 STEWART AVENUE, SUITE 114
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-227-2354
-----------------------------------------------------
Fax | 516-998-4078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 STEWART AVENUE, SUITE 114
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-227-2354
-----------------------------------------------------
Fax | 516-998-4078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | MR. ZACHARY MARWIL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 516-227-3254
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------