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General NPI Number Information
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NPI Number | 1295752285
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Entity Type | Organization
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Legal Business Name | GI LIVER DIAGNOSTICS, L.L.C.
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 829 57TH ST 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11220-3617
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Country | US
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Telephone | 718-871-2511
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Fax | 718-871-0062
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Provider Business Mailing Address
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Address Line | 93 BROWN CIR
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City | PARAMUS
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State | NJ
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Zip | 07652-5203
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Country | US
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Telephone | 718-871-2511
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KELLY CHIN
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Credential | M.D.
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Telephone | 718-871-2511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 195950
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License Number State | NY
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