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General NPI Number Information
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NPI Number | 1568451243
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Entity Type | Organization
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Legal Business Name | MASSAPEQUA GASTROENTEROLOGY ASSOC LLC
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 850 HICKSVILLE RD SUITE #100
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City | SEAFORD
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State | NY
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Zip | 11783
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Country | US
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Telephone | 516-796-9000
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Fax | 516-796-6360
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Provider Business Mailing Address
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Address Line | 850 HICKSVILLE RD SUITE #100
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City | SEAFORD
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State | NY
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Zip | 11783
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Country | US
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Telephone | 516-796-9000
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Fax | 516-796-6360
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Authorized Official
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Title or Position | OFFICE MGR
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Name | JANICE A HERRON
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Credential |
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Telephone | 516-796-9000
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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 |
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License Number State |
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