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General NPI Number Information
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NPI Number | 1629106885
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Entity Type | Organization
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Legal Business Name | DIGESTIVE HEALTH MEDICAL ASSOC. PC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 114 BIRCH DR
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2320
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Country | US
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Telephone | 516-741-7769
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Fax | 516-877-2012
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Provider Business Mailing Address
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Address Line | 114 BIRCH DR
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2320
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Country | US
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Telephone | 516-741-7769
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Fax | 516-877-2012
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD LAWRENCE BRONZO
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Credential | M.D.
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Telephone | 516-466-5166
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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 | 131009
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License Number State | NY
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