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General NPI Number Information
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NPI Number | 1699974881
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Entity Type | Organization
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Legal Business Name | GASTROENTROLOGY SERVICES OLM
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 600 E 233RD ST
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City | BRONX
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State | NY
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Zip | 10466-2604
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Country | US
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Telephone | 718-920-9070
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Fax |
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Provider Business Mailing Address
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Address Line | 158 W 27TH ST 11TH FLOOR SOUTH
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City | NEW YORK
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State | NY
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Zip | 10001-6216
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Country | US
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Telephone | 212-563-2627
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. HILLARY HERTAN
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Credential | M.D.
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Telephone | 718-920-9070
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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 | 156652
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License Number State | NY
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