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General NPI Number Information
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NPI Number | 1962782300
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Entity Type | Organization
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Legal Business Name | FARMINGDALE ENDOSCOPY
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 1111 RTE 110 SUITE 205
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City | EAST FARMINGDALE
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State | NY
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Zip | 11735
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Country | US
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Telephone | 631-752-7000
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Fax | 516-364-9796
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Provider Business Mailing Address
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Address Line | 1943 VINCENT LN
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City | SYOSSET
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State | NY
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Zip | 11791-9629
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Country | US
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Telephone | 516-650-1800
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Fax | 516-364-9796
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD CURTIS FAGAN
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Credential | M.D.
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Telephone | 516-650-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | NYS 178331
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License Number State | NY
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