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General NPI Number Information
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NPI Number | 1770906950
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Entity Type | Organization
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Legal Business Name | IG GASTROENTEROLOGY P.C.
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 2647 CONEY ISLAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11223
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Country | US
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Telephone | 718-382-0500
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Fax | 718-382-7025
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Provider Business Mailing Address
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Address Line | 70 WOODMERE BLVD
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City | WOODMERE
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State | NY
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Zip | 11598
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Country | US
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Telephone | 718-382-0500
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Fax | 718-382-7025
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | INNA GORDIN
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Credential | MD
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Telephone | 718-382-0500
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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 | 199895
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License Number State |
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