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General NPI Number Information
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NPI Number | 1487938346
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Entity Type | Organization
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Legal Business Name | FARMINGDALE ENDOSCOPY PLLC
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 245-02 HORACE HARDING EXP.
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City | LITTLE NECK
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State | NY
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Zip | 11362
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Country | US
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Telephone | 718-224-4100
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Fax | 718-224-4527
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Provider Business Mailing Address
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Address Line | 1943 VINCENT LN
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City | SYOSSET
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State | NY
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Zip | 11791-9629
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Country | US
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Telephone | 516-650-1800
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Fax | 516-364-9796
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD C FAGAN
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Credential | MD
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Telephone | 516-650-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 178331
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License Number State | NY
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