=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275586299
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHERN NEW YORK GASTROENTEROLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 53 PUBLIC SQ SUITE 202
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13601-2674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-786-8408
-----------------------------------------------------
Fax | 315-786-6368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 53 PUBLIC SQ SUITE 202
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13601-2674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-786-8408
-----------------------------------------------------
Fax | 315-786-6368
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARGOT M REMINGTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 315-786-8408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------