MEDICARE: NEW YORK ENDOSCOPY CENTER, LLC

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
1	207RG0100X	Gastroenterology Physician
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1306089180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK ENDOSCOPY CENTER, LLC

Provider Business Mailing Address
First Line	:	2 GANNETT DRIVE
Second Line	:	STE 104
City	:	WHITE PLAINS
State	:	NY
Zip	:	10604-3404
Country	:	US
Telephone Number	:	914-683-1619
Fax Number	:	914-372-9900

Provider Business Practice Location Address
First Line	:	2 GANNETT DRIVE
Second Line	:	STE 104
City	:	WHITE PLAINS
State	:	NY
Zip	:	10604-3404
Country	:	US
Telephone Number	:	914-683-1619
Fax Number	:	914-372-9900

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. ALFRED ROSTON
Credential	:	M.D.
Telephone Number	:	914-683-1619

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	05/31/2011

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