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General NPI Number Information
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NPI Number | 1407305063
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY OF WESTCHESTER, LLC
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 1086 N BROADWAY SUITE 50
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City | YONKERS
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State | NY
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Zip | 10701-1107
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Country | US
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Telephone | 914-375-2751
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Fax | 914-375-2831
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Provider Business Mailing Address
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Address Line | PO BOX 788
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City | HARRISON
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State | NY
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Zip | 10528-0788
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Country | US
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Telephone | 914-391-1274
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JOSE LANTIN
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Credential | MD
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Telephone | 914-391-1274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 161138B
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License Number State | NY
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