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General NPI Number Information
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NPI Number | 1568912145
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Entity Type | Organization
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Legal Business Name | DITMAS HEIGHTS GASTROENTEROLOGY PC
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 1111 OCEAN AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-2039
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Country | US
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Telephone | 718-975-3369
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Fax | 718-228-9887
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Provider Business Mailing Address
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Address Line | 1111 OCEAN AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-2039
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Country | US
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Telephone | 718-975-3369
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Fax | 718-228-9887
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Authorized Official
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Title or Position | OWNER
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Name | SAM WEISSMAN
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Credential | MD
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Telephone | 718-975-3369
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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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