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General NPI Number Information
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NPI Number | 1841421542
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Entity Type | Organization
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Legal Business Name | WEST LINCOLN ENDOSCOPY PLLC
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 20 W LINCOLN AVE SUITE 201
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City | VALLEY STREAM
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State | NY
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Zip | 11580-5730
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Country | US
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Telephone | 516-872-3885
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Fax |
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Provider Business Mailing Address
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Address Line | 20 W LINCOLN AVE SUITE 201
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City | VALLEY STREAM
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State | NY
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Zip | 11580-5730
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Country | US
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Telephone | 516-872-3885
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BARRY S DORF
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Credential | M.D.
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Telephone | 516-872-3885
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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 | 147051
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License Number State | NY
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