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NPI Code Detail

MEDICARE: NORTHEAST GASTROENTEROLOGY CENTER, INC.

MEDICARE: NORTHEAST GASTROENTEROLOGY CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1513306OTHERPAAETNA
2P006599OTHERPATRICARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164509287
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST GASTROENTEROLOGY CENTER, INC.
Provider Business Mailing Address
First Line : 10 PARK PLACE
Second Line :
City : HAZLE TOWNSHIP
State : PA
Zip : 18202-9394
Country : US
Telephone Number : 570-454-1400
Fax Number : 570-454-2144
Provider Business Practice Location Address
First Line : 10 PARK PL
Second Line :
City : HAZLE TOWNSHIP
State : PA
Zip : 18202-2885
Country : US
Telephone Number : 570-454-1400
Fax Number : 570-454-2144
Authorized Official
Title or Position : PRESIDENT
Name : DR. YOUNG KUL YOO
Credential : MD
Telephone Number : 570-454-1400
Provider Enumeration Date : 11/01/2006
Last Update Date : 09/06/2012

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Practice Location Address:
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1437544467 — LINDA YAN
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