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General NPI Number Information
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NPI Number | 1427214949
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY & NUTRITION, PC
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 10816 72ND AVE 2 FLOOR
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City | FOREST HILLS
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State | NY
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Zip | 11375-5653
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Country | US
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Telephone | 718-261-0900
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Fax | 718-261-0944
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Provider Business Mailing Address
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Address Line | 10816 72ND AVE 2 FLOOR
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City | FOREST HILLS
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State | NY
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Zip | 11375-5653
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Country | US
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Telephone | 718-261-0900
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Fax | 718-261-0944
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Authorized Official
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Title or Position | OFFICER
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Name | DR. SAMUEL DAVIDOFF
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Credential | MD
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Telephone | 718-261-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 229243
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License Number State | NY
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