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General NPI Number Information
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NPI Number | 1750701611
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Entity Type | Organization
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Legal Business Name | GOTHAM GASTROENTEROLOGY, PLLC
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 535 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10017-3620
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Country | US
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Telephone | 212-570-2075
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10021-2995
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PETER S KIM
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Credential | M.D.
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Telephone | 212-794-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 190910
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License Number State | NY
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