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General NPI Number Information
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NPI Number | 1306169263
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Entity Type | Organization
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Legal Business Name | FAMILY GASTRO, P.C.
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 9711 3RD AVE BSMT LEVEL
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City | BROOKLYN
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State | NY
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Zip | 11209-7702
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Country | US
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Telephone | 718-833-4742
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Fax | 718-836-4629
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Provider Business Mailing Address
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Address Line | 254 BIRCHWOOD PARK DR
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City | JERICHO
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State | NY
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Zip | 11753-2307
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Country | US
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Telephone | 718-833-4742
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Fax | 718-836-4629
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Authorized Official
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Title or Position | OWNER
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Name | DR. WAEL ELDARAWY
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Credential | M.D.
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Telephone | 516-849-7515
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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 | 245326
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License Number State | NY
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